bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and Factors of Burnout among Australian Orthopaedic Trainees: A Cross-Sectional Study
Authors: Arora Manit , Diwan Ashish D , Harris Ian A
Published: October 2016

Purpose.

To assess the prevalence and factors of burnout among Australian orthopaedic trainees.

Methods.

236 orthopaedic registrars of the Australian Orthopaedic Association were invited to participate in a 32-item survey by email. The questionnaire assessed potential factors associated with burnout, satisfaction with the choice of orthopaedics as a career and work-life balance, and subjective overall health, as well as 3 subscales of the Maslach Burnout Inventory – Human Services Survey for assessing burnout: emotional exhaustion, depersonalisation, and personal accomplishment. Participants with high levels of either emotional exhaustion or depersonalisation were defined as having burnout. Those with and without burnout were compared.

Results.

51 (22%) of the 236 trainees completed the questionnaire. Of whom, 88% were satisfied with their choice of orthopaedics as a career, whereas 27% were satisfied with their work-life balance. 27 (53%) respondents were considered burned out. Compared with those who did not burn out, those who burned out were less satisfied with their careers (p=0.004) and work-life balance (p=0.021).

Conclusion.

53% of Australian orthopaedic trainees were burned out. Burnout trainees were more likely to be dissatisfied with their career choice and work-life balance. Active interventions to combat burnout and improve work-life balance are needed.
Review Article: Total Hip Replacement in Haemodialysis or Renal Transplant Patients
Authors: Lieu David , Harris Ian A , Naylor Justine M , Mittal Rajat
Published: October 2016

25 studies involving 755 hips in 534 patients were reviewed to determine the complication rates of total hip replacement in haemodialysis or renal transplant patients. In comparison of both groups, renal transplant patients were generally younger and more likely to receive an uncemented implant, whereas haemodialysis patients had approximately twice the infection rate and higher rates of mortality, revision, aseptic loosening, and hip dislocation. Both groups had increased complication rates, compared with patients without renal failure.
Bony Ankylosis of the Knee Secondary to Heterotopic Ossification after Total Knee Arthroplasty: A Case Report
Authors: Chan PK , Chiu KY , Ng FY , Yan CH
Published: October 2016

We report a case of bony ankylosis of the knee secondary to severe and extensive heterotopic ossification over 9 years after primary total knee arthroplasty in a 71-year-old woman.
Use of Sutures as Kirschner Wire and Tensionband Wire for Olecranon Fractures: A Technical Note
Authors: Henseler JF , van der Zwaal P , Dijkstra PDS
Published: October 2016

Open reduction and internal fixation using tension-band wires for displaced olecranon fractures enables restoration of extensor function. We report on 3 elderly patients with a displaced olecranon fracture who underwent open reduction and internal fixation using sutures as the Kirschner wire and tension-band wire and achieved good outcome.
Zancolli Lasso Procedure for Correction of Paralytic Claw Hands
Authors: Gupta Vikas , Consul Ashu , Swamy MKS
Published: October 2016

Purpose.

To evaluate the outcome of 20 claw hands corrected with the Zancolli lasso procedure.

Methods.

20 patients aged 7 to 48 (mean, 28) years with claw hand deformity for a mean of 33.3 months secondary to leprosy (n=17), traumatic ulnar nerve injury (n=2), or tardy ulnar nerve palsy (n=1) underwent the Zancolli lasso procedure, in which the flexor digitorum superficialis (FDS) of the middle finger was divided in to 4 slips (one for each finger) and reattached to itself after passing through the proximal pulley. Deformity, power, movement, and function of the hands were evaluated before and after surgery.

Results.

The mean duration of surgery was 58.4 (range, 50–107) minutes. The mean duration of follow-up was 18 (range, 12–24) months. Deformity correction was good in 15 patients, fair in 3, and poor in 2. The mean angle improvement was maximum in the little finger, followed by the ring, index, and middle fingers. The transverse metacarpal arch (compared with the normal hand) was increased/reversed in 7 patients and decreased in 13 patients. The grip and pinch strength increased in 13 patients, remained unchanged in 6, and decreased in one. Motion and function of the hand was good in 12 patients, fair in 6, and poor in 2. One patient developed swan neck deformity in the little finger owing to suture tension of the transferred slip, and another had paraesthesia over the index finger. They underwent reoperation using the FDS of the ring finger; no sensory or motor recovery was achieved.

Conclusion.

The Zancolli lasso procedure is easy to perform and does not require extensive postoperative training. It restores synchronous finger flexion and spares other superficialis tendons, thus avoiding swan neck deformity of the fingers.
Effects of Anticoagulants on Outcome of Femoral Neck Fracture Surgery
Authors: Ginsel Bastiaan L , Taher Ahmad , Whitehouse Sarah L , Bell Jack J , Pulle Chrys R , Crawford Ross W
Published: October 2016

Purpose.

To review records of 330 patients who underwent surgery for femoral neck fractures with or without preoperative anticoagulation therapy.

Methods.

Medical records of 235 women and 95 men aged 48 to 103 years (mean, 81.6; standard deviation [SD], 13.1) who underwent surgery for femoral neck fractures with or without preoperative anticoagulation therapy were reviewed. 30 patients were on warfarin, 105 on aspirin, 28 on clopidogrel, and 167 were controls. The latter 3 groups were combined as the non-warfarin group and compared with the warfarin group. Hospital mortality, time from admission to surgery, length of hospital stay, return to theatre, and postoperative complications (wound infection, deep vein thrombosis, and pulmonary embolism) were assessed.

Results.

The warfarin and control groups were significantly younger than the clopidogrel and aspirin groups (80.8 vs. 80.0 vs. 84.2 vs. 83.7 years, respectively, p<0.05). 81% of the patients underwent surgery within 48 hours of admission. The overall mean time from admission to surgery was 1.8 days; it was longer in the warfarin than the aspirin, clopidogrel, and control groups (3.3 vs. 1.8 vs. 1.6 vs. 1.6 days, respectively, p<0.001). The mean length of hospital stay was 17.5 (SD, 9.6; range, 3–54) days. The overall hospital mortality was 3.9%; it was 6.7% in the warfarin group, 3.8% in the aspirin group, 3.6% in the clopidogrel group, and 3.6% in the control group (p=0.80). Four patients returned to theatre for surgery: one in the warfarin group for washout of a haematoma, 2 in the aspirin group for repositioning of a mal-fixation and for debridement of wound infection, and one in the control group for debridement of wound infection. The warfarin group did not differ significantly from non-warfarin group in terms of postoperative complication rate (6.7% vs. 2.7%, p=0.228) and the rate of return to theatre (3.3% vs. 1%, p=0.318).

Conclusion.

It is safe to continue aspirin and clopidogrel prior to surgical treatment for femoral neck fracture. The risk of delaying surgery outweighs the peri-operative bleeding risk.
Salvage of Infected Non-Union of the Tibia with An Ilizarov Ring Fixator
Authors: Khan Muhammad Shahid , Rashid Haroon , Umer Masood , Qadir Irfan , Hafeez Kamran , Iqbal Arshad
Published: October 2016

Purpose.

To review outcomes of 24 patients who underwent Ilizarov ring fixation for infected non-union of the tibia.

Methods.

Medical records of 21 men and 3 women aged 13 to 74 (mean, 38) years who underwent Ilizarov ring fixation for infected non-union of the tibia were reviewed. The mean bone defect was 3.3 (range, 2–5) cm. The mean time from injury to presentation was 11.9 (range, 1–36) months. The mean number of previous surgeries was 2 (range, 0–14). A local flap was used in 2 patients and a free flap was used in one patient. Nine of the patients underwent Ilizarov ring fixation without soft tissue and bony resection, as inadequate stability was the reason for non-union. Patients were assessed using the Association for the Study and Application of the Method of Ilizarov criteria.

Results.

Patients were followed up for a mean of 11 (range, 8–46) months. Functional outcome was excellent in 8 patients, good in 12, fair in 2, and failure in one, whereas bone union outcome was excellent in 6 patients, good in 14, fair in one, and poor in 2. The mean time to union was 8 (range, 3–31) months. The mean external fixation index was 4.2 (range, 1.5–15.7) cm/month. Complications encountered were pin tract infection (n=5), re-fracture (n=2), soft tissue impingement by Ilizarov rings (n=2), recurrence of wound infection (n=1), mal-union (n=1), and mortality (n=1).

Conclusion.

Ilizarov ring fixation is a viable option for infected non-union of the tibia. Adequate assessment of bone union is crucial before removal of fixator to prevent re-fracture.
Infection Rates in Singaporeans with and without Complicated Diabetes after Ankle Fracture Surgery
Authors: Tan Tong Leng , Oh Jacob YL , Kwek Ernest Beng Kee
Published: October 2016

Purpose.

To compare infection rates in Singaporeans with and without complicated diabetes after ankle fracture surgery.

Methods.

Medical records of 18 men and 27 women aged 38 to 84 (mean, 62) years with complicated (n=12) or uncomplicated (n=33) diabetes who underwent internal fixation for closed ankle fractures were reviewed. Complicated diabetes was defined as having end organ dysfunction. The control of diabetes was categorised as good (n=19), fair (n=10), and poor (n=16), based on HbA1c level within 4 months before or after surgery. Patients were followed up at weeks 2, 6, 12, and 24, with bone union as the end point.

Results.

The mean follow-up period was 9 (range, 4–12) months. 2 (6%) of 33 patients with uncomplicated diabetes and 6 (50%) of 12 patients with complicated diabetes developed superficial or deep infection. No patient died or underwent amputation secondary to infection. In multivariable logistic regression analysis after adjusting for co-morbidities, only complicated diabetes was a risk factor for postoperative infection (odds ratio=11.85, p=0.01). The odds of postoperative infection was 11.85 times higher in patients with complicated diabetes than with uncomplicated diabetes.

Conclusion.

In patients with complicated diabetes, careful patient selection, peri-operative precaution, and closer monitoring are recommended if surgery is necessary.
Preoperative Antibiotics for Septic Arthritis in Children: Delay in Diagnosis
Authors: MacLean Simon BM , Timmis Christopher , Evans Scott , Lawniczak Dominik , Nijran Amit , Bache Edward
Published: October 2016

Purpose.

To review the records of 50 children who underwent open joint washout for septic arthritis with (n=25) or without (n=25) preoperative antibiotics.

Methods.

Records of 50 children who underwent open joint washout for presumed septic arthritis with (n=25) or without (n=25) preoperative antibiotics were reviewed. 17 boys and 8 girls aged 3 weeks to 16 years (median, 1.5 years) who were prescribed preoperative antibiotics before joint washout were compared with 12 boys and 13 girls aged one month to 14 years (median, 2 years) who were not. Following arthrotomy and washout, all patients were commenced on high-dose intravenous antibiotics. Patients were followed up for 6 to 18 months until asymptomatic.

Results.

Patients who were referred from places other than our emergency department were twice as likely to have been prescribed preoperative antibiotics (p=0.0032). Patients prescribed preoperative antibiotics had a longer median (range) time from symptom onset to joint washout (8 [2–23] vs. 4 [1–29] days, p=0.05) and a higher mean erythrocyte sedimentation rate (93.1 vs. 54.3 mm/h, p=0.023) at presentation. Nonetheless, the 2 groups were comparable for weight bearing status, fever, and positive culture, as well as the mean (range) duration of antibiotic treatment (4.9 [4–7] vs. 4.7 [1–8] weeks, p=0.586).

Conclusion.

Preoperative antibiotics should be avoided in the management of septic arthritis in children. Their prescription delays diagnosis and definitive surgery, and leads to additional washouts and complications. A high index of suspicion and expedite referral to a specialist paediatric orthopaedic unit is needed if septic arthritis is suspected.
Tuberculosis of the Calcaneus in Children
Authors: Agarwal Anil , Kant Kumar Shashi , Suri Tarun , Gupta Neeraj , Verma Indreshwar , Shaharyar Abbas
Published: October 2016

Purpose.

To review 10 children with calcaneal tuberculosis in terms of presentation, healing, and functional outcome.

Methods.

Medical records of 7 boys and 3 girls aged 7 to 12 (mean, 9.8) years who presented with calcaneal tuberculosis were reviewed. The erythrocyte sedimentation rate of all patients was elevated. All patients presented with pain and swelling around the lateral malleolus and a ‘heal-up’ sign; 7 of them presented with an additional discharging sinus. Three patients had palpable lymph nodes in the right inguinal or left popliteal region. Symptoms had lasted for one month to 1.5 years. Two patients had healed tuberculosis in the lungs; 8 patients had no pulmonary involvement. Seven patients had a single lytic lesion in the calcaneal body (n=1), tuberosity (n=3), and extension to anterior process (n=3). Three patients had multiple lytic lesions in the calcaneum; one of them had bilateral involvement who had lesions in the phalanges, lumbar spine, and ulna. Two patients had subtalar joint involvement.

Results.

The mean follow-up period was 17 (range, 8–60) months. The erythrocyte sedimentation rate returned to normal after 3 months in 7 patients and after >6 months in 3 patients. The subtalar range of movement was normal in all except for 2 patients. One patient developed subtalar ankylosis. Sinuses healed in a mean of 10 (range, 2–16) weeks. No patient had pain on level walking after treatment. At 3 months, remineralisation of bone was evident in all patients. Sclerosis of cavity margins and sequestra resorption was noted from 6 to 9 months. No patient experienced recurrence.

Conclusion.

The ‘heel up’ sign was common in children with calcaneal tuberculosis in this endemic region. The central granuloma-type presentation was the most common. Pathological fractures and involvement of the subtalar joint were not common. Subtalar joint involvement was a poor prognostic factor.
Effects of Thermoablation with or without Caffeine on Giant Cell Tumour of Bone
Authors: Pimolsanti Rapin , Wongkajornsilpa Adisak , Chotiyarnwong Pojchong , Asavamongkolku Apichart , Waikakul Saranatra
Published: October 2016

Purpose.

To evaluate the effect of caffeine on the apoptosis rate of giant cell tumour of bone cells during thermoablation.

Methods.

Giant cell tumour of bone tissue (2 cm3) was collected from 10 patients. Cells were incubated at 37°C, 40°C, 45°C, 50°C, 52.5°C, and 55°C for 20 minutes (3 tubes for each temperature). Caffeine was added to the tubes in amounts of 0 μg/ml (control), 50 μg/ml, and 100 μg/ml. The apoptotic effect of thermoablation with or without caffeine was evaluated.

Results.

In all test conditions, the apoptotic rate of tumour cells increased when the temperature increased. Compared with controls (no caffeine), adding 50 or 100 μg/ml of caffeine did not increase the apoptotic rate significantly at 40°C to 52.5°C. Caffeine had no enhancing effect at any temperature. Conversely, at 55°C, the apoptotic rate was lower when 100 μg/ml of caffeine was added than when no or 50 μg/ml of caffeine added (p=0.045).

Conclusion.

Thermoablation at 40°C to 52.5°C for 20 minutes increased the apoptosis rate of giant cell tumour of bone cells. Caffeine had no enhancing effect at any temperature. Conversely, at 55°C, caffeine had cytoprotective effects on the tumour cells against thermoablation.
Review Article: Outcome of Total Knee Arthroplasty in Obese Patients
Authors: Rodriguez-Merchan E Carlos
Published: October 2016

The MEDLINE database was searched using the key words: ‘obesity’ and ‘knee arthroplasty’. 41 articles focused on the topic were reviewed; most studies were prospective case series (providing low-level evidence) and 3 were systematic reviews. 16 studies reported no adverse association between obesity and total knee arthroplasty (TKA) outcome, whereas 24 studies reported a poorer TKA outcome in obese patients. In the 3 systematic reviews, obesity was reported to adversely affect the outcome, the rate of complications, implant survival, and the cost of TKA.
Development of a Pelvic Discomfort Index to Evaluate Outcome following Fixation for Pelvic Ring Injury
Authors: Borg Tomas , Hernefalk Bjorn , Carlsson Marianne , Larsson Sune
Published: October 2016

Purpose.

To develop a pelvic discomfort index (PDI) to evaluate outcome following fixation for pelvic ring injury.

Methods.

29 female and 44 male consecutive patients (mean age, 36 years) underwent internal fixation for pelvic ring injury of type B1 (n=10), B2 (n=22), B3 (n=15), C1 (n=18), C2 (n=5), and C3 (n=3), based on the AO/OTA classification. At postoperative 6, 12, and 24 months, patients were asked to assess their discomfort in the pelvis using a 14-item questionnaire. Three questions were open-ended, and responses were categorised by a single assessor. The remaining 11 questions were closed-ended and had 6 ordinal options from ‘no discomfort’ (score=0) to ‘extremely severe discomfort’ (score=5). The content validity and relevance of the 11 closed-ended questions was determined. The 14-item questionnaire was compared with the 36-item Short Form Health Survey (SF-36).

Results.

Respectively at postoperative 6, 12, and 24 months, 78%, 71%, and 71% of the patients completed the 14-item questionnaire. Based on the factor analysis and responses to the open-ended questions, the number of items was reduced to 6 including pain, walking, mobility of the hips, loss of sensation in the legs, sexual life, and operation scar. Four factors could explain 96% of the total variance. The first factor involved the first 3 items (pain, walking, and hip motion) and addressed ‘pelvis’, whereas 3 factors involved the remaining items and each addressed peripheral neurology, sexual life, and operation scar. A PDI was developed using these 6 items. The PDI had high internal reliability (α=0.89), adequate content and criterion validity, and moderate correlation with the SF-36 total score or scores of physical function, bodily pain, and general health ( r=0.50–0.77).

Conclusion.

The PDI provides valid, specific, and relevant information to assess outcome following fixation for pelvic ring injury.
Screw Length in Volar Locking Plate Fixation for Distal Radial Fractures
Authors: Yuen Grace , Yee Dennis KH , Fang Christian , Lau Tak-Wing , Leung Frankie
Published: October 2016

Purpose.

To develop a reference for the distal screw length in volar locking plate fixation for distal radial fractures in an East Asian population.

Methods.

12 pairs of forearm specimens from 11 male and one female East Asian cadavers were scanned using computed tomography. On sagittal images of the distal radius, the mean cortex-to-cortex distance of 8 quadrants was measured as a reference for the distal screw length. In addition, intra-operative 3-dimensional fluoroscopy of 10 male and 10 female patients who underwent volar locking plate fixation for distal radial fractures was used to validate the distal screw length in the cadaveric reference. 76 distal locking screws were applied in the 8 quadrants; their cortex-to-cortex distances were measured.

Results.

The mean cortex-to-cortex distances at quadrants A, B, C, D, E, F, G, and H were 15.4 mm, 19.6 mm, 20.8 mm, 20.0 mm, 13.3 mm, 18.0 mm, 18.8 mm, and 17.4 mm, respectively. In 45% of the specimens, the 2 screws inserted at quadrants C and D were longest. Distal screws (quadrants A to D) were significantly longer than proximal screws (quadrants E to H) [p=0.02]. In intra-operative 3-dimensional fluoroscopic images, 2 of the 76 distal locking screws penetrated the dorsal cortex (one in quadrant A and one in quadrant F). The mean screw length was 88.0% of the cortex-to-cortex distance. Referenced to the cadaveric data, 88.2% of the screws could be safely inserted without penetrating the dorsal cortex, and the remaining 11.8% of screws (5 at quadrant D, one at quadrant B, and 3 at quadrant C; all in female patients) could potentially cause dorsal cortex penetration of 2 to 4 mm. In male patients, the mean screw length was 76.1% of the cortex-to-cortex distance based on the cadaveric reference. In female patients, when the screw length was 4 mm less than the cadaveric reference, the mean screw length would be 72.0% of the referenced cortex-to-cortex distance, with no dorsal cortex penetration.

Conclusion.

In female patients, the screw length should be 4 mm less than the cadaveric reference to avoid dorsal cortex penetration.
One-Year Multidrug Treatment for Tuberculosis of the Cervical Spine in Children
Authors: Agarwal Anil , Kant Kumar Shashi , Kumar Anubrat , Shaharyar Abbas
Published: October 2016

Purpose.

To review the clinical and radiological features and treatment outcome in 22 children who underwent one-year antitubercular multidrug treatment for tuberculosis of the cervical spine.

Methods.

Records of 13 boys and 9 girls aged 2 to 12 (mean, 9.1) years who underwent one-year antitubercular multidrug treatment for tuberculosis of the cervical spine were reviewed. Tuberculosis involved the atlantoaxial region (C1–C2) in 7 patients, mid-cervical region (C3–C7) in 8, cervicodorsal region (C6–T3) in 3, contiguous multilevels in 2, and non-contiguous multifocal areas in 2. The mean number of vertebrae involved was 2.8 (range, 1–8). The mean symptom duration was 2.5 (range, 0.25–6) months. Three patients had neurological deficits. Antitubercular multidrug treatment included an intensive phase for 2 months and a continuation phase for 10 months, using isoniazid, rifampicin, pyrazinamide, and ethambutol.

Results.

At a mean of 2.25 (range, 0.5–5) years after treatment, no patient had recurrence, pain, or dynamic instability. Full range of movement was achieved after a mean of 2.7 (range, 1–4) months in all but 3 patients. In the 3 patients with neurological deficits, recovery was achieved after a mean of 8 (range, 5–14) weeks. Soft tissue swelling resolved after a mean of 11 (range, 8–12) weeks. Remineralisation of vertebrae occurred after a mean of 2 (range, 2–6) months. Spontaneous vertebral fusion occurred in only 6 of 22 patients after a mean of 36 (range, 18–72) months. Three patients developed kyphotic deformity.

Conclusion.

Antitubercular multidrug treatment is a viable option for children with tuberculosis of the cervical spine, even in the presence of neurological deficits. Development of deformity is not common; interbody fusion is usually delayed. Patients with contiguous multilevel involvement with vertebral erosion or collapse should be closely monitored for development of late deformity.
Tibial Tuberosity–Trochlear Groove Distance in Chinese Patients with or without Recurrent Patellar Dislocation
Authors: Tse Michael Siu Hei , Lie Chester Wai Hung , Pan Nin Yuan , Chan Chi Hin , Chow Hung Lit , Chan Wai Lam
Published: October 2016

Purpose.

To compare the tibial tuberosity–trochlear groove (TTTG) distance in Chinese patients with or without recurrent patellar dislocation.

Methods.

The TTTG distance of 14 knees in 5 men and 9 women aged 16 to 38 years with recurrent patellar dislocation were compared with that of 73 control knees using magnetic resonance imaging.

Results.

The mean TTTG distance was significantly greater in patients with recurrent patellar dislocation than in controls (16.4 mm vs. 10.1 mm, p<0.001). Six (43%) knees with recurrent patellar dislocation had the TTTG distance greater than the cut-off threshold of 16.4 mm, compared to none in controls.

Conclusion.

The TTTG distance is related to height and is shorter in Chinese than Caucasian patients; the threshold for tibial tuberosity transfer should be lower in Chinese patients.
Autologous Morselised Bone Grafting for Medial Tibial Defects in Total Knee Arthroplasty
Authors: Sugita Takehiko , Aizawa Toshimi , Sasaki Akira , Miyatake Naohisa , Fujisawa Hirokazu , Kamimura Masayuki
Published: October 2016

Purpose.

To evaluate the outcome of autologous morselised bone grafting for a medial tibial defect of ≥10 mm deep in 45 total knee arthroplasties (TKAs).

Methods.

38 patients aged 46 to 85 (mean, 73) years underwent 45 TKAs and autologous morselised bone grafting for a medial tibial defect of ≥10 (range, 10–25) mm in depth by a single surgeon. In the first 19 TKAs, 2 resected subchondral bone plates from the lateral tibial plateau were driven into 2 gutters made on the floor of the medial tibial defect as bony support posts. Morselised cancellous bone grafts were then impacted around these posts. In the remaining 26 TKAs, multiple drill holes were made on the floor of the defect to decrease the remodelling time. Morselised cancellous bone grafts were impacted to fill the defects. The tibial components were fixed with cemented (n=34) or non-cemented (n=11) technique. Internal fixation devices were not used; stem extension was used in only 2 TKAs (in a patient with Charcot joint and a patient undergoing revision TKA).

Results.

After a mean follow-up duration of 65 (range, 24–174) months, no patient showed gait disturbance. The mean knee flexion angle was 113.8° (range, 90°–130°). No absorption or collapse of the grafted bone, or component loosening were noted on radiographs. The grafted bone completely incorporated into the host bone, with bony trabeculae crossing the interface within 2 years in the first 19 TKAs and within one year in the latter 26 TKAs. The margin of the grafted area resembled bony cortex in 30 TKAs.

Conclusion.

Autologous morselised bone grafting is a viable option for most medial tibial defects during TKA.
Gender Difference in Outcome after Total Knee Replacement
Authors: Lim Jason Beng Teck , Chi Chong Hwei , Lo Lup Ean , Lo Woon Theng , Chia Shi-Lu , Yeo Seng Jin , Chin Pak Lin , Tay Keng Jin Darren , Lo Ngai Nung
Published: October 2016

Purpose.

To compare the outcome after primary total knee replacement (TKR) for end-stage knee osteoarthritis (OA) in men versus women.

Methods.

Records of 214 men and 1040 women who underwent primary TKR for end-stage knee OA and were followed up for a minimum of 2 years were reviewed. Knee flexion, Oxford Knee Score, Knee Society Score (KSS), and 8 subscores of Short Form 36 (SF-36) were recorded preoperatively and at postoperative 6 months and 2 years.

Results.

Men and women were comparable only in age (67.9 vs. 67.3 years, p=0.244); men had a lower mean body mass index (27.0 vs. 28.3 kg/m2, p<0.001). Preoperatively, men had better knee flexion (117° vs. 114.8°, p=0.05), Oxford Knee Score (33.5 vs. 36.8, p<0.001), KSS knee score (44.3 vs. 40.3, p=0.001), KSS function score (52.5 vs. 47.1, p<0.001), and all 8 subscores of SF-36 (p=0.005 to p<0.001). Compared with men, women achieved greater improvement at 6 months in Oxford Knee score (13.2 vs. 15.1, p=0.009) and KSS knee score (36.9 vs. 41.6, p=0.016), and at 2 years in Oxford Knee Score (15.0 vs. 17.9, p<0.001), KSS knee score (39.8 vs. 43.9, p=0.009), and SF-36 subscores of social functioning (23.6 vs. 35.1, p<0.001) and mental health (3.9 vs. 8.2, p=0.003).

Conclusion.

Compared with men, women had poorer preoperative knee flexion, Oxford Knee Score, KSS, and 8 subscores of SF-36, but achieved greater improvement in the Oxford Knee Score and KSS knee score at 6 months and 2 years, as well as in SF-36 subscores of social functioning and mental health at 2 years.
Development of Secondary Ossification Centres of the Acromion in Japanese Youth: A Computed Tomographic Study
Authors: Fujii Koji , Takeda Yoshitsugu , Miyatake Katsutoshi
Published: October 2016

Purpose.

To determine the age range when the secondary ossification centres of the acromion appear and fuse in Japanese youth using computed tomography (CT).

Methods.

CT scans of 85 shoulders in 35 male and 14 female consecutive patients aged 6 to 20 (mean, 16) years were reviewed. No patient had pain or tenderness at the acromion. Appearance and fusion of the secondary ossification centres of the acromion were determined twice by an orthopaedist. A secondary ossification centre was considered to have appeared when a low-density line was noted at the juxta-epiphyseal area and to have fused when the line had disappeared. Intra-observer reliability was determined.

Results.

The intra-observer reliability was 0.93. The secondary ossification centres of the acromion had appeared at around 10 years of age and had fused at around 15 years of age, with one exception.

Conclusion.

In these Japanese subjects, the secondary ossification centres of the acromion had appeared at around 10 years of age and had fused at 15 to 16 years.
Outcome following Total Knee Arthroplasty in Obese versus Non-Obese Asian Patients
Authors: Goh Graham Seow-Hng , Liow Ming Han Lincoln , Mitra Amit Kanta
Published: October 2016

Purpose.

To compare the outcome following total knee arthroplasty (TKA) in obese and non-obese Asian patients.

Methods.

27 obese patients were compared with 27 non-obese controls matched for age, gender, diagnosis (osteoarthritis), prosthesis, preoperative Knee Society knee and function scores, preoperative Oxford Knee Score, and follow-up duration. All TKAs were performed by a single surgeon. Patients were assessed at 6 months and 2 years for the range of motion, Knee Society knee and function scores, Oxford Knee Score, and Short Form-36 Health Survey (SF-36).

Results.

The obese and non-obese groups did not differ significantly in pre- and post-operative variables: range of motion, Knee Society knee and function scores, Oxford Knee Score, and SF-36 score. Using revision as an end-point, implant survival was 100%. There were no intra- or post-operative complications in either group.

Conclusion.

Obese and non-obese Asian patients achieved a comparable outcome following TKA.
Total Knee Arthroplasty in Women with Asymptomatic Urinary Tract Infection
Authors: Singh Harjoban , Thomas Simon , Agarwal Shekhar , Arya Subhash C , Srivastav Shekhar , Agarwal Naresh
Published: October 2016

Purpose.

To compare early outcome after total knee arthroplasty (TKA) in women with a positive or negative urine culture.

Methods.

128 women underwent bilateral (n=89) or unilateral (n=39) primary TKA. Diabetes mellitus was present in 38%, obesity in 53%, and asymptomatic urinary tract infection (positive urine culture) in 36% of women. Women with a positive or negative urine culture were compared.

Results.

In the 46 women with a positive urine culture, Escherichia coli (n=29) and Klebsiella (n=17) were grown. Women with a positive or negative urine culture were comparable in terms of the incidence of diabetes (28% vs. 43%, p=0.1), obesity (52% vs. 54%, p=0.87), fever (9% vs. 15%, p=0.32), leucocytosis (28% vs. 17%, p=0.13), and delayed wound healing (0% vs. 1%, p=0.45).

Conclusion.

Women with or without a positive urine culture had comparable early complication rates following TKA.
The Neviaser Portal for Superior Glenoid Anchor Insertion: An Anatomic Study
Authors: Haughton Benjamin Alexander , Serrano-Pedraza Ignacio , Boada Eduardo , Candal-Couto Jaime Jose
Published: October 2016

Purpose.

To measure the angular relationship between the Neviaser portal and the superior glenoid labrum in 60 cadaveric specimens to determine whether this portal can be used for reliable anchor placement.

Methods.

The Neviaser portal of 30 left and 30 right unpaired dry cadaveric scapulae with clavicles were measured by a single observer using an analogue vernier caliper. The angular relationship between the Neviaser portal and the 12 o'clock position of the glenoid labrum was calculated.

Results.

13 of the 60 scapulae were excluded from analysis, because the Neviaser portal was medial to the glenoid rim making safe anchor insertion unfeasible. For the remaining 47 scapulae, the mean angles α and β were 58.2° and 57.9°, respectively. Compared with the ideal angles α and β of 30° and 0°, respectively, all the 47 Neviaser portals were more posterior (relative to the 12 o'clock position) and closer to the transverse plane, making insertion of suture anchors in the optimum position unfeasible, except for one that was within 10° of the ideal angles in both planes.

Conclusion.

Reliable insertion of suture anchors at the 12 o'clock position of the glenoid labrum through the Neviaser portal is unfeasible in most patients.
Tuberculosis of the Sternoclavicular Joint
Authors: Jain Anuj , Jajodia Nitesh , Aggarwal Aditya , Singh Jaswinder , Gupta Siddharth
Published: October 2016

Purpose.

To review the diagnosis and treatment of tuberculosis of the sternoclavicular joint in 13 patients.

Methods.

Records of 9 men and 4 women aged 26 to 47 (mean, 36.5) years who presented with tuberculosis of the right (n=8) or left (n=5) sternoclavicular joint were reviewed.

Results.

All 13 patients had a raised erythrocyte sedimentation rate at presentation. Nine patients presented with systemic symptoms including malaise, fever, or loss of weight/appetite. Local symptoms included cold abscess (n=5), tenderness and non-fluctuant swelling (n=4), and discharging sinus (n=4). The mean duration of symptoms was 2.7 (range, 1–7) months. Four patients had multifocal involvement of the proximal ulna (n=1), lung (n=2), and meninges (n=1). Aspiration (n=3), fine needle aspiration cytology (n=4), drainage (n=2), or curettage (n=4) of the swelling, abscess, or sinus was performed, and the diagnosis was confirmed by histopathology (n=8), polymerase chain reaction (n=5), or culture (n=1). Two patients were diagnosed based on clinical suspicion. 11 patients responded to antituberculous therapy (ATT), and symptoms resolved after 6 to 8 weeks. Two patients did not respond to ATT after 3 months and were screened for immunocompromising disorders or drug resistance. Their CD4 count and CD4:CD8 ratio was low, and an immunomodulation regimen was prescribed as an adjunct to ATT.

Conclusion.

A high level of clinical suspicion is needed to diagnose tuberculosis of the sternoclavicular joint in patients with pain/tenderness, discharging sinus, or cold abscess. A combination of histopathological and microbiological tests, and PCR can confirm the diagnosis.
Volar Locking Plate Osteosynthesis for Distal Radial Fractures
Authors: Javed Saqib , Shahid Rizwan , Thimmiah Ravi , El-Deen Muj
Published: October 2016

Purpose.

To review the one-year outcome after volar locking plate fixation for distal radial fractures.

Methods.

Records of 22 men and 40 women aged 17 to 86 (mean, 52.5) years who underwent volar locking plate fixation for distal radial fractures were reviewed. According to the Fernandez classification, the distal radial fractures were classified as type 1 (n=20), type 2 (n=24), type 3 (n=6), type 4 (n=6), or type 5 (n=6). Three types of plate were used: Stryker Variax (n=33), Synthes LCP (n=20), and Smith & Nephew Peri-Loc (n=9). Wrist function was assessed at one year using the validated patient-rated wrist evaluation (PRWE) questionnaire.

Results.

14 (23%) of the 62 patients had 24 complications: stiffness (n=13), median nerve symptoms (n=4), malunion (n=2), implant removal for persistent pain and stiffness but no improvement shown (n=2), complex regional pain syndrome (n=2), and carpal arthritis (n=1). The complication rates for types 1, 2, 3, 4, and 5 fractures were 20%, 17%, 67%, 0%, and 33%, respectively (p=0.052). The complication rates for low-risk (types 1 and 2) and high-risk (types 3, 4, and 5) fractures were 18% and 33%, respectively (p=0.315). The complication rates for Stryker Variax, Synthes LCP, and Smith & Nephew Peri-Loc were 26%, 20%, and 14%, respectively (p=0.75). At one year, the mean PRWE score was comparable in patients with low-risk or high-risk fractures (14 vs. 19, p=0.5). 79%, 13%, and 8% of the patients recovered >50%, 20–50%, and <20% of range of movement of the contralateral side, respectively.

Conclusion.

Volar locking plate fixation followed by early rehabilitation for distal radial fractures achieved good outcome, with a low rate of implant-related complications.
Driving with a Short Arm Cast in a Simulator
Authors: Mansour Damian , Mansour Kristin Gotaas , Kenny Benjamin William , Attia John , Meads Bryce
Published: October 2016

Purpose.

To test the ability to steer in a driving simulator in subjects with a short arm cast.

Methods.

17 men and 13 women aged 23 to 67 (mean, 37) years who had a valid driver's licence were randomised to the cast-first group (n=16; 7 had the cast on the dominant arm) or the cast-second group (n=14; 8 had the cast on the dominant arm) and drove in a simulator. A short arm plaster-of-Paris cast was applied in a neutral position, allowing free movement of the metacarpophalangeal joints, thumb, and elbow joint. Outcome measures included the number of driving off track instances, the number of crashes, the lap time, and the effect of hand dominance on these parameters. Subjects were asked whether the cast had impeded their steering ability.

Results.

Subjects with or without a cast were comparable in terms of the number of driving off track instances, number of crashes, and lap time. Compared with no cast, the odds ratio (OR) of a subject in a cast driving off the track was 1.02 (p=0.921) and having a crash was 0.79 (p=0.047). All subjects were 1.23 times more likely to drive off the track in their first lap (OR=2.66, p=0.019). The mean lap time decreased for each consecutive lap from the 2nd to 5th laps. Subjects driving with a cast on the dominant or non-dominant arm were comparable. 26 out of the 30 participants considered that the plaster cast impeded their steering ability.

Conclusion.

Compared with no cast, driving with a short arm cast did not significantly decrease steering ability in a driving simulator.
Percutaneous Repair Followed by Accelerated Rehabilitation for Acute Achilles Tendon Ruptures
Authors: Al-Mouazzen Louay , Rajakulendran Karthig , Najefi Ali , Ahad Nurul
Published: October 2016

Purpose.

To evaluate the outcome after percutaneous repair followed by accelerated rehabilitation for acute Achilles tendon ruptures.

Methods.

21 men and 9 women (mean age, 41 years) underwent percutaneous repair by a single senior surgeon for acute Achilles tendon ruptures, followed by early weight bearing and accelerated rehabilitation. Outcome measures included the Achilles tendon re-rupture rate, the Achilles tendon total rupture score (ATRS) at 3 and 6 months, the incidence of sural nerve injury, wound infection, wound dehiscence, patient satisfaction, and the time to return to pre-rupture activity.

Results.

The mean follow-up period was 12.5 months. The mean ATRS score improved from 57.65 at 3 months to 86.95 at 6 months (p<0.001). No patient had intra-operative complications, tendon re-rupture, sural nerve injury, wound dehiscence, or deep infection. Two patients developed a superficial wound infection, which was resolved with oral flucloxacillin. Two patients had a mass at the transverse incision, but neither had any symptoms or functional restriction. All patients were able to bear full weight comfortably without the walker boot at 8 weeks, and return to their work by 3 months. The mean time to return to pre-rupture activity, including sports, was 10.4 months. The mean satisfaction rate was 87% at 6 months.

Conclusion.

Percutaneous repair of the Achilles tendon followed by early weight bearing and accelerated rehabilitation achieves good functional outcome.
Forefoot Flexibility and Medial Tibial Stress Syndrome
Authors: Kudo Shintarou , Hatanaka Yasuhiko
Published: October 2016

Purpose.

To investigate the association between medial tibial stress syndrome (MTSS) and morphology and flexibility of the foot arches.

Methods.

131 feet from 74 healthy subjects and 31 feet from 27 patients with MTSS were classified as normal feet (n=78 in 40 subjects), flat feet (n=53 in 34 subjects), or MTSS feet (n=31 in 27 patients). The medial longitudinal arch (MLA) ratio and the transverse arch length (TAL) were measured in both rearfoot and forefoot loading positions. The difference between the 2 positions indicated the flexibility of the MLA (diff–MLA ratio) and the transverse arch (diff-TAL).

Results.

The MLA ratio was higher in normal feet than MTSS feet or flat feet (15.1% vs. 12.8% vs. 12.3%, p<0.001). The diff-TAL was lower in MTSS feet than normal feet or flat feet (0.4% vs. 0.8% vs. 0.9%, p<0.001]). The 3 groups were comparable in terms of the diff–MLA ratio and the TAL. Respectively for the MLA ratio and the diff-TAL, the cut-off value was 11.9% and 0.61% based on the Youden index. The sensitivity, specificity, and odds ratio of the cut-off value were 0.4, 0.9, and 4.8 for the MLA ratio, and 0.6, 0.7, and 9.8 for the diff-TAL, respectively.

Conclusion.

Decreased flexibility of the transverse arch and decreased MLA ratio are risk factors for MTSS. In contrast, the flexibility of the MLA and the height of the transverse arch were not risk factors for MTSS.
Curettage without Bone Grafting for a Simple Bone Cyst in the Capitate
Authors: Bishay Sherif Naseef Girgis
Published: October 2016

Purpose.

To review the outcome after intralesional curettage without bone grafting for simple bone cysts in the capitate.

Methods.

Records of 12 hands in 10 consecutive females aged 14 to 21 (mean, 17.5) years who underwent intralesional curettage without bone grafting for a simple bone cyst in the capitate were reviewed. Clinical outcome was evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Wrist/hand pain was assessed using the modified Mayo wrist score. Patient satisfaction, range of motion, and grip strength were self-evaluated as improved, unchanged, or worse.

Results.

After a mean follow-up of 7.5 (range, 2.5–12.5) years, the mean DASH score was 12.3 (range, 0–25), and the mean modified Mayo wrist score was 85 (range, 70–95); the modified Mayo wrist score was excellent in 8 hands and good in 4 hands. All patients had bone union and preservation of capitate height. All patients had no pain except for 2 patients (4 hands) who reported pain after strenuous activity. All patients had improved range of motion, and all but 2 patients had improved grip strength.

Conclusion.

Curettage without bone grafting for a simple bone cyst in the capitate is a sufficient and viable option.
Correlation between Survival and Tumour Characteristics in Patients with Chondrosarcoma
Authors: Kamal Achmad Fauzi , Husodo Kurniadi , Prabowo Yogi , Hutagalung Errol Untung
Published: October 2016

Purpose.

To evaluate the correlation between survival and tumour characteristics in 23 patients with chondrosarcoma.

Methods.

Records of 15 men and 8 women aged 14 to 66 (mean, 37) years who were diagnosed with primary (n=19) or secondary (n=4) chondrosarcoma of the axial skeleton (n=8), proximal extremity (n=9), or distal extremity (n=6) were reviewed. The tumour diameter was <10 cm in 4 patients, 10–19 cm in 12, and 20–30 cm in 7. The tumour involved the intramedullary in 17 and the periosteum in 6 patients; tumour extension was intracompartmental in 5 and extracompartmental in 18 patients. The Evans histological grade for the tumours was grade 1 in 6 patients, grade 2 in 10, and grade 3 in 7. The mean tumour size was 12.3 cm for grade 1 tumours, 18.2 cm for grade 2 tumours, and 18.3 cm for grade 3 tumours. 13 patients had no metastasis and 3 of 10 patients with grade 2 tumours and all 7 patients with grade 3 tumours had metastasis to the lung at presentation. 17 patients underwent surgery, one underwent adjuvant treatment only, and 5 declined treatment.

Results.

The mean follow-up period for the 23 patients was 3.1 years (range, 3 weeks to 9 years). The 5-year survival rate was 43% overall, 83.3% for grade 1 tumours, 50% for grade 2 tumours, and 0% for grade 3 tumours. The median survival duration was 20 (95% confidence interval, 11–29) months. Two patients had local recurrence and 16 did not, and the 5 patients who declined treatment died. Survival correlated with Evans histological grading (p=0.004), the presence of metastasis at presentation (p=0.026) and local recurrence (p=0.004).

Conclusion.

The survival rate was lower in patients with higher Evan grading, metastasis, or local recurrence.
Increase in Quality and Quantity of Orthopaedic Studies from 2002 to 2012
Authors: Little Zoe , Newman Simon , Dodds Alex , Spicer Dominic
Published: October 2016

Purpose.

To compare the level of evidence of orthopaedic studies published in 2002 and 2012 to determine whether the quality and quantity of studies have increased.

Methods.

The top 10 orthopaedic journals in 2002 and 2012 were identified, according to the Thomson Reuters impact factor. The level of evidence of each clinical article between January and June in 2002 and 2012 were determined by 2 senior orthopaedic trainees, according to the Oxford Centre for Evidence-based Medicine 2011 Levels of Evidence. Basic science articles, case reports, and non-systematic reviews were excluded. The proportions of papers designated to each level of evidence in 2002 and 2012 were compared, as was the mean level of evidence of studies in 2002 and 2012.

Results.

In 2002, 379 clinical articles were identified and their level of evidence was level 1 (n=3), level 2 (n=67), level 3 (n=71), and level 4 (n=238). In 2012, 642 clinical articles were identified and their level of evidence was level 1 (n=26), level 2 (n=113), level 3 (n=167), and level 4 (n=336). The proportion of level 4 articles decreased from 62.8% in 2002 to 52.3% in 2012 (p=0.001), whereas the proportion of level 1 articles increased from 0.8% to 4.1% (p=0.002) and level 3 articles increased from 18.7% to 26.0% (p=0.008). The mean level of evidence improved from 3.44 in 2002 to 3.27 in 2012 (p=0.002).

Conclusion.

The quality and quantity of orthopaedic studies have increased from 2002 to 2012, but most studies remained of a low level of evidence.
Clinical and Financial Benefits of Intra-Articular Tranexamic Acid in Total Knee Arthroplasty
Authors: Goyal Navendu , Chen Darren B , Harris Ian A , Rowden Neville , Kirsh George , MacDessi Samuel J
Published: October 2016

Purpose.

To determine whether intra-articular tranexamic acid (TXA) use after total knee arthroplasty (TKA) results in decreased postoperative blood transfusion and length of hospital stay.

Methods.

Medical records of 1981 patients (mean age, 69.2 years) who underwent primary TKA with (n=1006) or without (n=975) TXA use by any of 4 knee arthroplasty surgeons were reviewed. TXA (3000 mg/30ml) was administered via an epidural catheter into the knee joint after wound closure. Postoperative blood transfusion was given to patients with haemoglobin (Hb) level <80 g/dl on days 1 and 2 or with symptoms of acute anaemia.

Results.

Intra-articular TXA use after TKA resulted in a lower blood transfusion rate (4.5% [45/1006] vs. 14.8% [144/975], p<0.0001), fewer units of blood transfused (86 vs. 313 units, p<0.0001), fewer units of blood transfused per 100 patients (8.5 vs. 32.1, p<0.0001), and shorter length of hospital stay (4.7±2.3 vs. 5.3±2.7 days, p<0.0001). Total cost savings with respect to the reduction in blood transfusion was AU$143.68 per patient. When the change in length of hospital stay and TXA costs were included, the overall saving was AU$631.36 per patient.

Conclusion.

Intra-articular TXA use can reduce costs as a result of decreased blood transfusion rate and length of hospital stay in patients undergoing TKA.