bluuebunny/crossref_metadata_2025 huggingface dataset:
Mixing Implants of Differing Metallic Composition in the Treatment of Upper-extremity Fractures
Authors: Acevedo Daniel , Loy Bo Nasymuth , Lee Brian , Omid Reza , Itamura John
Published: August 2014

Mixing implants with differing metallic compositions has been avoided for fear of galvanic corrosion and subsequent failure of the implants and of bone healing. The purpose of this study was to evaluate upper-extremity fractures treated with open reduction and internal fixation with metallic implants that differed in metallic composition placed on the same bone. The authors studied the effects of using both stainless steel and titanium implants on fracture healing, implant failure, and other complications associated with this method of fixation. Their hypothesis was that combining these metals on the same bone would not cause clinically significant nonunions or undo clinical effects from galvanic corrosion.

A retrospective review was performed of 17 patients with upper-extremity fractures fixed with metal implants of differing metallic compositions. The primary endpoint was fracture union. Eight clavicles, 2 proximal humeri, 3 distal humeri, 3 olecranons, and 1 glenoid fracture with an average follow-up 10 months were reviewed. All fractures healed. One patient experienced screw backout, which did not affect healing.

This study implies that mixing implants with differing metallic compositions on the same bone for the treatment of fractures does not adversely affect bone healing. No evidence existed of corrosion or an increase in complications with this method of treatment. Contrary to prior belief, small modular hand stainless steel plates can be used to assist in reduction of smaller fracture fragments in combination with anatomic titanium plates to obtain anatomic reduction of the fracture without adversely affecting healing.
Isolated Ulnar Dorsal Cutaneous Nerve Herpes Zoster Reactivation
Authors: Kayipmaz Murat , Basaran Serdar Hakan , Ercin Ersin , Kural Cemal
Published: August 2014

Herpes zoster is a viral disease presenting with vesicular eruptions that are usually preceded by pain and erythema. Herpes zoster can be seen in any dermatome of the body but most commonly appears in the thoracic region. Herpes zoster virus is typically transmitted from person to person through direct contact. The virus remains dormant in the dorsal ganglion of the affected individual throughout his or her lifetime. Herpes zoster reactivation commonly occurs in elderly people due to normal age-related decline in cell-mediated immunity. Postherpetic neuralgia is the most common complication and is defined as persistent pain or dysesthesia 1 month after resolution of the herpetic rash.

This article describes a healthy 51-year-old woman who experienced a burning sensation and shooting pain along the ulnar dorsal cutaneous nerve. Ten days after the onset of pain, she developed cutaneous vesicular eruption and decreased light-touch sensation. Wrist and fourth and fifth finger range of motion were painful and slightly limited. Muscle strength was normal. Nerve conduction studies indicated an ulnar dorsal cutaneous nerve lesion. She was treated with anti-inflammatory and antibiotic drugs and the use of a short-arm resting splint. At 5-month follow-up, she reported no residual pain, numbness, or weakness.

Herpes zoster in the upper extremity may be mistaken for entrapment neuropathies and diseases characterized by skin eruptions; ulnar nerve zoster reactivation is rarely seen. The authors report an uncommon ulnar dorsal cutaneous nerve herpes zoster reactivation. Clinicians should be aware of this virus during patients’ initial evaluation.
Surgical Treatment of Ideberg Type III Glenoid Fractures With Associated Superior Shoulder Suspensory Complex Injury
Authors: Qin Hui , Hu Chuan-Zhen , Zhang Xian-Long , Shen Long-Xiang , Xue Zi-Chao , An Zhi-Quan
Published: August 2014

Ideberg type III glenoid fractures with associated superior shoulder suspensory complex (SSSC) injuries are rare, and related treatments have not been reported in the literature. The purpose of this study was to evaluate the clinical outcomes of such injuries treated with open reduction and internal fixation (ORIF).

Between July 2007 and April 2012, ten patients with Ideberg type III glenoid fractures were surgically treated using ORIF with 2 cannulated screws or a screw combined with a metacarpal plate through an anterior approach. Patients with associated SSSC injuries underwent ORIF with K-wires or plates. Information was available for 9 patients with a mean follow-up of 24.1±18.2 months. Mean bone-healing time was 8.4±2.2 weeks. At last follow-up, mean forward flexion of the operative shoulder was 157.8°±7.5°, mean external rotation was 62.9°±7.9°, and mean internal rotation was thoracic level T6±0.8. Mean Constant score was 84.1±3.7 points, which was a mean of 92.7%±3.4% of that seen in the contralateral shoulder. Mean UCLA score and Disabilities of the Arm, Shoulder and Hand score were 33.6±1.7 and 16.6±7.7, respectively.

The results show that Ideberg type III glenoid fractures with associated SSSC injuries can be successfully treated using ORIF through an anterior approach. Glenoid fractures and SCCC injuries should be treated simultaneously.
Congenital Stenosis and Adjacent Segment Disease in the Cervical Spine
Authors: Eubanks Jason David , Belding Jon , Schnaser Erik , Rowan Andrew , Moffitt Gable , Weaver John , Reich Michael S. , Bechtel Chris , Xie Ke , Gande Abhiram , Hohl Justin , Braly Brett , Hilibrand Alan , Kang James D.
Published: August 2014

Symptomatic adjacent segment disease (ASD) after anterior cervical fusion (ACF) is reported in 25% of patients at 10 years postoperatively. Debate continues as to whether this degeneration is due to the natural history of the disk or the changed biomechanics after ACF. This study explored whether congenital stenosis predisposes patients to an increased incidence of ASD after ACF.

A retrospective review of 635 patients with myelopathy or radiculopathy was performed; 364 patients had complete records for review. Patients underwent 1- to 5-level ACF (94 one-level, 145 two-level, 79 three-level, 45 four-level, and 1 five-level). Radiographs were evaluated for bony congenital stenosis using validated parameters, and ASD was measured according to Hilibrand’s criteria and correlated with symptomatic ASD. Congenital stenosis was found in 21.7% of patients and radiographic ASD in 33.5%, with a significant association between these parameters. However, symptomatic ASD occurred in 11.8% of patients; no association between congenital stenosis and symptomatic ASD or myelopathy and ASD was found. Clinical results demonstrated excellent or good Robinson scores in 86.2% of patients and Odom scores in 87% of patients.

Despite mostly excellent to good outcomes, symptomatic ASD is common after ACF. Although congenital stenosis appears to increase the incidence of radiographic ASD, it does not appear to predict symptomatic ASD.
BASK Presentations: Progress to Journal Publication
Authors: Mihok Peter , Worley Samuel , Hassaballa Mohammed , Punwar Shahid , Porteous Andrew , Murray James
Published: August 2014

Scientific conferences, such as the British Association for Surgery of the Knee (BASK) annual meeting, provide an important channel for the exchange of information between researchers. However, the ultimate means of disseminating research information is publication in a relevant peer-reviewed journal. The goal of this study was to follow up published abstracts in the
Journal of Bone and Joint Surgery, British Volume
supplement from the annual BASK conference and determine how many presented abstracts progressed to article publication in a peer-reviewed journal.

Combined Google Scholar and PubMed searches of 602 BASK abstract titles over a 10-year period were performed, and the resulting articles were reviewed to confirm that they were directly associated with the corresponding abstracts. Two hundred (33.2%) abstracts presented at BASK conferences over a 10-year period were found in online or print format. This amount is comparable with other similar conferences’ publication rates. Only one-third of abstracts presented at the BASK conference were converted to journal publication as full articles. This may be due to multiple rejections, lack of time, relocation of the authors, or a reluctance to publish negative findings. Alternatively, changes in an abstract’s title for publication prevents online search engines from identifying the final article and may explain some disparity. Furthermore, presented abstracts may not survive the strict peer-review process required for journal publication. Because these findings from BASK mirror other specialty meetings, clinicians should accept the results of orthopedic meeting proceedings with some level of caution.
Open Versus Percutaneous Release for the Treatment of Trigger Thumb
Authors: Guler Ferhat , Kose Ozkan , Ercan Emrah Cevat , Turan Adil , Canbora Kerem
Published: August 2014

The purpose of this retrospective study was to compare the outcomes and complications of conventional open surgical release and percutaneous needle release in the treatment of trigger thumb. The study comprised 87 patients with trigger thumb who were treated with either open pulley (n=52) or percutaneous (n=32) release between 2008 and 2011. All patients were reevaluated at a mean follow-up of 22.7±9.6 months (range, 9–44 months).

Main outcome measures were the rate of recurrence, pain on movement or tenderness over the pulley, infection rate, digital nerve injury, tendon bowstringing, joint stiffness or loss of thumb range of motion, and patient satisfaction. The groups were statistically similar regarding age, sex, laterality, dominant side involvement, and trigger thumb grade on initial admission. At final follow-up, no patient had recurrence, tendon bowstringing, joint stiffness, or loss of thumb range of motion. No patients in the open pulley release group and 2 (5.7%) patients in the percutaneous release group had a digital nerve injury (
P
=.159). No statistical difference was found in the infection rate between groups (
P
=.354). A total of 98.1% of patients in the open pulley release group and 97.1% of patients in the percutaneous release group were satisfied with treatment (
P
=.646). Both techniques resulted in similar therapeutic efficacy, and the rate of potential complications was also statistically similar in each group.

Although statistically insignificant, the authors believe that the 5.7% rate of iatrogenic digital nerve injury seen in the percutaneous release group is clinically significant and serious. Therefore, they advocate using open surgical release of trigger thumb.
Biomechanical Comparison of Axial Load Between Cannulated Locking Screws and Noncannulated Cortical Locking Screws
Authors: Yang Shan-Wei , Kuo Shyh Ming , Chang Shwu Jen , Su Tian-Shiang , Chen Hsiang-Ho , Renn Jenn-Huei , Lin Ting-Sheng
Published: August 2014

The goal of this study was to compare the biomechanical stability of cannulated locking screws and noncannulated cortical locking screws in a periarticular locking plate. Twelve fresh-frozen porcine tibias with a 1-cm gap created distal to the tibial plateau were used to simulate an unstable proximal tibial fracture. All specimens were fixed with a periarticular proximal lateral tibial locking plate and divided into 2 groups based on whether the proximal metaphyseal screw holes of the plate were inserted with either cannulated locking screws or noncannulated cortical locking screws.

An axial compressive load was applied to cause failure in each specimen using a materials testing instrument. The axial stiffness and maximum failure strength in axial loading were recorded. Axial stiffness of the constructs using noncannulated cortical locking screw was significantly higher than that of the constructs using cannulated locking screws (
P
=.006). Axial failure strength of the constructs using noncannulated cortical locking screw was significantly higher than that of the constructs using cannulated locking screws (
P
=.002). The failure mode observed in all specimens was a permanent screw-bending deformity over the head-shaft junction of proximal metaphyseal screws, irrespective of whether they were cannulated or noncannulated cortical locking screws.

Fixation with noncannulated cortical locking screws offered more stability than cannulated locking screws with regard to axial stiffness and failure strength in a porcine model with unstable proximal tibial fractures.
Unique Failure Mechanism of a Femoral Component After Revision Total Hip Arthroplasty
Authors: Martin J. Ryan , Trousdale Robert T.
Published: August 2014

As the prevalence of revision total hip arthroplasty increases, the mechanisms of failure of these revisions have become better delineated. Several studies have indicated infection, instability, and aseptic loosening to be the more common mechanisms of failure in revision surgery. However, with increasing numbers of revisions performed, unique mechanisms of failure are being seen, likely related to the implants that are used in the revision setting.

Revision implants offer certain advantages over primary implants with the use of modular components. The revision implants allow the surgeon to increase offset and leg length with modular femoral bodies and necks. However, these modular junctions represent additional areas for implant failure. These new methods of failure associated with modular implants are slowly presenting as the use of these implants continues to increase.

The authors recently encountered a mechanism of failure that, to their knowledge, has not been described in the literature. They report a 57-year-old man with dissociation of the proximal body from the diaphyseal component of a Wright Medical Link (Memphis, Tennessee) stem prosthesis. The patient presented with an audible click on physical examination, and radiographs confirmed dissociation of the proximal body. The intraoperative findings, treatment method, and proposed mechanisms for this type of failure are presented, as well as insight into potential ways to avoid this type of failure.
Bony Humeral Avulsion of the Glenohumeral Ligament
Authors: Tilbrook Linda K. , Vickaryous Brian K. , Bancroft Laura W.
Published: August 2014

A 51-year-old man sustained an anterior shoulder dislocation during a motor vehicle accident. Radiographs and noncontrast magnetic images were obtained. resonance images were obtained.
Total Knee Arthroplasty After High Tibial Osteotomy
Authors: Cerciello Simone , Vasso Michele , Maffulli Nicola , Neyret Philippe , Corona Katia , Panni Alfredo Schiavone
Published: August 2014

Educational Objectives

As a result of reading this article, physicians should be able to:

1.

Delineate the indications for high tibial osteotomy (HTO) and report on its functional results in relation to the conversion to total knee arthroplasty (TKA).

2.

Outline the principles and anatomic implications of opening- and closing-wedge HTO.

3.

Describe how to undertake soft tissue balance in the knees of patients who previously underwent HTO.

4.

Analyze tibial malunions after HTO and their implications for further HTO and TKA.

High tibial osteotomy may be indicated in the treatment of varus knee in young, active patients. The preservation of proprioception and native joint and biomechanics is crucial for functional recovery in these patients. However, deterioration of initial good results can occur with time. In such cases, revision with total knee arthroplasty is indicated. However, this is a more surgically demanding option compared with a primary prosthesis. Accurate preoperative planning is mandatory to decrease the risk of intraoperative complications. A precise surgical technique, which is crucial to improving functional outcomes, includes hardware removal, joint exposition, tibial deformities due to previous osteotomy, and managing soft tissue mismatches. Possible technical challenges and surgical solutions exist for each of these aspects. However, several studies report lower functional results compared with primary implants. Thus, patients should be informed before high tibial osteotomy about its failure rate, the difficult surgical aspects of an additional prosthesis, and less satisfactory clinical results. [
Orthopedics.
2014; 37(3):191–198.]
Influence of Nail Prominence and Insertion Point on Anterior Knee Pain After Tibial Intramedullary Nailing
Authors: Chen Chun-Yu , Lin Kai-Cheng , Yang Shan-Wei , Tarng Yih-Wen , Hsu Chien-Jen , Renn Jenn-Huei
Published: August 2014

Chronic anterior knee pain is the most common complication after tibial nail insertion. Its etiology remains unknown, and multifactorial sources have been suggested. The authors believe that nail prominence and the insertion point of the nail are important in the development of anterior knee pain. The purpose of this retrospective study was to evaluate the roles of the insertion point and nail prominence in anterior knee pain after tibial intramedullary nailing using a transtendinous approach and a common nail type. A total of 108 patients with tibial shaft fractures underwent reamed intramedullary nailing using a transtendinous approach between 2006 and 2009. Mean follow-up was 26.8±5.0 months. A visual analog scale (0–100) was used to estimate anterior knee pain severity while patients performed 7 activities retrospectively. Radiographic assessments, including nail prominence and insertion point, were performed. Sixty (55.6%) patients experienced knee pain (group P) and 48 (44.4%) did not (group N). Significant differences were not found between the groups with respect to demographics, nail diameters, or fracture classifications. Less superior and more anterior nail prominences in radiographic assessments were significantly associated with anterior knee pain. When the insertion point was over the bottom half of the anterior cortex, the influence of anterior nail prominence was more obvious. Nail removal resulted in diminished pain during the 7 assessed activities. Nail insertion should be over the bottom half of the anterior cortex, with minimal anterior nail prominence. If anterior knee pain occurs, removal of the nail should be considered.
Minimally Invasive Plate Osteosynthesis Using a Helical Plate for Metadiaphyseal Complex Fractures of the Proximal Humerus
Authors: Moon Jun-Gyu , Kwon Hyuk-Nam , Biraris Sandeep , Shon Won-Yong
Published: August 2014

Minimally invasive plate osteosynthesis (MIPO) has been used for humeral shaft fractures, but concerns exist about soft tissue injuries. The purpose of this study was to report the surgical technique and clinical outcomes of MIPO using a helical plate for metadiaphyseal complex humeral shaft fractures. Twelve patients with acute displacement involving proximal and middle third humeral shaft fractures (AO type C) were treated using the MIPO technique with a helical plate. Fracture union, complications, and functional outcomes were evaluated using the Constant-Murley score and Mayo Elbow Performance Score (MEPS) at final follow-up. All fractures united at an average of 17.9 weeks. No major complications, such as neurovascular injury, infection, and nonunion, were observed. Mean Constant-Murley and MEPS scores at final follow-up were 88.6 and 97.9, respectively. A MIPO technique using a helical plate can be a useful surgical option for metadiaphyseal complex fractures of the humeral shaft.
Effect of Depression on Femoral Head Avascular Necrosis From Femoral Neck Fracture in Patients Younger Than 60 Years
Authors: He Dong , Xue Yuan , Li ZhiYang , Tang YanMing , Ding HuaiRong , Yang Zhong , Zhang Chao , Zhou HuiFang , Zhao Ying , Zong YaQi
Published: August 2014

The purpose of this study was to determine the effect of depression on femoral head avascular necrosis (AVN) from femoral neck fracture in patients younger than 60 years and the relationship between depression and postoperative quality of life. The Beck Depression Inventory-II (BDI-II) was completed by 641 patients (352 men and 289 women; average age, 41.7±10.2 years; range, 20–60 years) postoperatively. Patients were divided into groups according to BDI-II score: a depressed group (BDI-II score of 14 or higher) and a nondepressed group (BDI-II score lower than 14). They were followed for an average of 28 months (range, 24–37 months). The postoperative diagnosis was confirmed by typical radiographs and single photon-emission computed tomography. Quality of life among patients was assessed using the Short Form-36 (SF-36) questionnaire. The overall incidences of depression and AVN were 30.6% (196 of 641) and 20.9% (134 of 641), respectively. Ninety-four (48.0%) patients in the depressed group and 40 (9.0%) patients in the nondepressed group ultimately developed AVN. Symptoms of depression significantly affected AVN. In addition, depression predicted patients’ quality of life, as did sex, partner status, employment status, living alone, frequency of exercise, severity of fractures, and length of hospital stay. In a multiple linear regression model analyzing all of these variables, depression was the best independent predictor of quality of life. Depression in patients younger than 60 years with femoral neck fractures may increase postoperative femoral head AVN risk and greatly affect patients’ quality of life.
Effects of Total Knee and Hip Arthroplasty on Body Weight
Authors: Duchman Kyle R. , Gao Yubo , Phisitkul Phinit
Published: August 2014

Patients frequently report functional and subjective improvement following total hip (THA) and knee arthroplasty (TKA), but these improvements do not correlate with decreased body weight at 1- and 2-year follow-up. The purpose of this retrospective study was to investigate changes in body weight following THA and TKA at longer follow-up than the 1- to 2-year follow-up frequently reported in the literature. A retrospective review of patients undergoing THA and TKA, as well as other commonly performed lower extremity orthopedic surgeries, was completed for January 2002 to October 2011 at a single tertiary care facility. Adults who underwent a single lower extremity orthopedic procedure during that time period were included in the study. Patients undergoing THA and TKA were analyzed for clinically and statistically significant weight changes at 1- and minimum 2-year follow-up. At a mean follow-up of 4.82 years, TKA resulted in a statistically significant decrease in mean body weight (1.47 kg;
P
=.0109). This finding was unique to TKA. The proportion of individuals who experienced clinically significant weight loss between the 1- and minimum 2-year follow-up was higher than the proportion of individuals who gained clinically significant weight over the same time period following THA and TKA. The results of this study suggest that clinically significant weight loss may continue for several years beyond the 1- and 2-year follow-up that is frequently reported in the literature.
Intraoperative CT in the Assessment of Posterior Wall Acetabular Fracture Stability
Authors: Cunningham Brian , Jackson Kelly , Ortega Gil
Published: August 2014

Posterior wall acetabular fractures that involve 10% to 40% of the posterior wall may or may not require an open reduction and internal fixation. Dynamic stress examination of the acetabular fracture under fluoroscopy has been used as an intraoperative method to assess joint stability. The aim of this study was to demonstrate the value of intraoperative ISO computed tomography (CT) examination using the Siemens ISO-C imaging system (Siemens Corp, Malvern, Pennsylvania) in the assessment of posterior wall acetabular fracture stability during stress examination under anesthesia. In 5 posterior wall acetabular fractures, standard fluoroscopic images (including anteroposterior pelvis and Judet radiographs) with dynamic stress examinations were compared with the ISO-C CT imaging system to assess posterior wall fracture stability during stress examination. After review of standard intraoperative fluoroscopic images under dynamic stress examination, all 5 cases appeared to demonstrate posterior wall stability; however, when the intraoperative images from the ISO-C CT imaging system demonstrated that 1 case showed fracture instability of the posterior wall segment during stress examination, open reduction and internal fixation was performed. The use of intraoperative ISO CT imaging has shown an initial improvement in the surgeon’s ability to assess the intraoperative stability of posterior wall acetabular fractures during stress examination when compared with standard fluoroscopic images.
Free Vascularized Fibular Grafting for Patients Receiving Postoperative Corticosteroids
Authors: Ding Hao , Chen Sheng-Bao , Gao You-Shui , Lin Sen , Zhang Chang-Qing
Published: August 2014

Free vascularized fibular grafting (FVFG) is an effective method to treat corticosteroid-induced osteonecrosis of the femoral head (ONFH). Some patients continued to receive maintenance doses of corticosteroids to treat the primary disease postoperatively. This study was performed to evaluate outcomes of FVFG for corticosteroid-induced ONFH in patients who continued to receive corticosteroids postoperatively. The authors retrospectively reviewed the records of 44 patients (78 hips) who had received corticosteroid treatment for their primary disease after FVFG. They were followed up for at least 2 years (mean, 5.6 years). Demographic details, Harris Hip scores, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and radiographic data were collected and analyzed. The mean Harris Hip score for all hips was 70.9±9.9 points before surgery and increased to 84±12.1 points at the latest follow-up. There were also significant increases (
P
<.05) in physical component summary score and mental component summary score. According to the latest radiographic evaluation, 49 hips (62.8%) appeared improved, 10 hips (12.8%) appeared unchanged, and only 19 hips (24.4%) appeared worse. Seven hips (9%) underwent total hip arthroplasty during the follow-up period. Therefore, the results showed that FVFG was a viable method of treating corticosteroid-induced ONFH in patients who receive maintenance doses of corticosteroids postoperatively.
Tibial Tubercle Osteotomy With Screw Fixation for Total Knee Arthroplasty
Authors: Chinzei Nobuaki , Ishida Kazunari , Kuroda Ryosuke , Matsumoto Tomoyuki , Kubo Seiji , Iguchi Tetsuhiro , Chin Takaaki , Akisue Toshihiro , Nishida Kotaro , Kurosaka Masahiro , Tsumura Nobuhiro
Published: August 2014

This study investigated the efficacy of tibial tubercle osteotomy (TTO) with screw fixation as part of the surgical treatment of primary complicated total knee arthroplasty (TKA) and revision TKA. From January 2000 to April 2011, 15 patients (15 knees) underwent revision TKA and 20 patients (21 knees) underwent primary TKA. The average patient age was 68.7±8.7 years. Patients underwent follow-up at the authors’ institution for an average of 60.6±32.9 months. Comparison of preoperative and postoperative Knee Society Scores and Knee Society Functional Scores showed significant postoperative improvement (
P
<.05). Moreover, postoperative range of motion of the knee improved from 88.5°±33.8° to 104.3°±18.2° (
P
<.05). Radiographic assessment showed that the average period to bone union was 10.8±5 weeks (range, 5
–
28 weeks), the average length of the bone fragment was 59.4±5.9 mm, the average width at the proximal end was 18.9±2.9 mm, and the average thickness at the proximal end of the osteotomy was 10.3±1.2 mm. Tibial tubercle osteotomy provided wide exposure for TKA while protecting the extensor mechanism. Solid bone-to-bone fixation was achieved using TTO with 2 screws, and although the overall complication rate was 8.3%, none of the complications were associated with TTO itself. It is recommended that the bone fragment be 60 mm long, 20 mm wide, and 10 mm thick at the proximal end. Appropriate size of the osteotomized bone and solid screw fixation are essential to prevent complications during this procedure.
Human Beta-Defensin-3 for the Diagnosis of Periprosthetic Joint Infection and Loosening
Authors: Liu Guo-Dong , Yu Hong-Jun , Ou Shan , Luo Xi , Ni Wei-Dong , Huang Xian-Kai , Chen Ji-Ying , Wang Yan , Javard Parvizi , Fei Jun
Published: August 2014

In this study, the difference in expression of human beta-defensin-3 in periprosthetic tissue and cancellous bone was observed in the periprosthetic tissue and cancellous bone of patients in the periprosthetic joint infection group, the aseptic loosening group, and the spacer treatment group as well as the synovial membrane and ilium of the normal control group. Hematoxylin and eosin staining of the synovial tissue showed different levels of neutrophil infiltration in all groups except for the normal control group. Immunofluorescence staining of periprosthetic tissue and cancellous bone showed the most positive cells expressing human beta-defensin-3 and the largest mean optical density in the periprosthetic joint infection group, followed by the aseptic loosening group, the spacer treatment group, and the normal control group, with a significant difference in comparison between the periprosthetic joint infection group and the other 3 groups (
P
<.01). White blood cell count, erythrocyte sedimentation rate, and C-reactive protein level were highest in the periprosthetic joint infection group, whereas no difference was found between the other 3 groups. Taken together, high levels of human beta-defensin-3 protein expression were found in the periprosthetic tissue and cancellous bone of patients with periprosthetic joint infection and aseptic loosening, but there are differential expressions of human beta-defensin-3, and this may provide a new marker for the differential diagnosis of infection and loosening of the artificial joint.
Smoking Synthetic Marijuana Leads to Self-Mutilation Requiring Bilateral Amputations
Authors: Meijer Karim A. , Russo Russell R. , Adhvaryu Dhaval V.
Published: August 2014

Synthetic cannabinoids have become a worldwide epidemic because they provide a sometimes legal, easily accessible, and presumably safe alternative to marijuana. Recently published reports have linked acute psychosis, myocardial infarctions, convulsions, self-harm, and even terrorist organizations to these designer substances. This case report outlines the first reported case of Black Diamond, a synthetic cannabis, leading to a self-inflicted burn to the bilateral upper extremities requiring a transradial amputation of the right arm and a toe transfer procedure of the left hand after loss of all digits. The patient presented to the emergency department with self-inflicted fourth-degree burns to the bilateral hands and forearms with second-degree burns of the face, for a total body surface area of 14.5%. The patient was found by firefighters with his hands aflame on his kitchen stove. With no previous medical or psychiatric history and collateral information to confirm the patient’s mental status prior to use of Black Diamond, the patient’s acute psychotic episode was attributed to Black Diamond. After multiple procedures and a lengthy recovery, the patient completed his post-graduate education and entered the professional world. As orthopedic surgeons, we should be involved in educating the public on the harm of these designer drugs, including self-mutilation. The popularity of synthetic drugs in the United States will continue to present a major challenge to all health care providers. Orthopedists are on the front lines of this epidemic because these drugs push patients into risky, traumatic behavior.
Hip Flexion Contracture Caused by an Intraspinal Osteochondroma of the Lumbar Spine
Authors: Pourtaheri Sina , Emami Arash , Stewart Tyler , Hwang Ki , Issa Kimona , Harwin Steven F. , Mont Michael A.
Published: August 2014

Osteochondroma (or osteocartilaginous exostosis) is the most common bone tumor of childhood, with an incidence ranging from 1 to 1.4 per 1,000,000. In the lumbar spine, osteochondromata usually arise from the posterior column at the secondary ossification center and grow away from the spinal canal without causing neurologic deficits. This article reports a rare intraspinal lumbar osteochondroma that compressed the thecal sac, resulting in a hip flexion contracture in an 11-year-old boy. This lumbar, intraspinal, extradural exostosis was confluent with the L3 inferior articular process and compressed the L3 nerve root and thecal sac severely. The patient underwent an en bloc resection of the tumor with a right-sided hemilaminectomy of L3 and L4, a right-sided partial facetectomy at L3 to L4, and an extended resection from the pars intra-articularis of the L2 to the L5 vertebrae. The tumor specimen measured 4.8×3.7×2.5 cm with clear margins. Instrumented posterolateral fusion was completed from L2 to L5 due to iatrogenic instability from the resection. The patient had an uneventful recovery and returned to his normal activities of daily living, including sports. He remains asymptomatic at 54-month follow-up. A solitary lumbar osteochondroma that compresses the spinal cord, resulting in a motor neurological deficit, has not been reported in a pediatric patient. Orthopedic surgeons should be aware of potential intraspinal presentation of osteochondromas. Magnetic resonance imaging is the modality of choice in diagnosing and screening for spinal osteochondromas. These cases can be treated with resection surgery.
Arthrometric Stability of Horizontal Versus Vertical Single-bundle Arthroscopic Anterior Cruciate Ligament Reconstruction
Authors: Denti Matteo , Arrigoni Paolo , Volpi Piero , Bait Corrado , Sedran Jean Claude , Randelli Pietro
Published: August 2014

The anteroposterior (AP) stability of standard anterior cruciate ligament (ACL) reconstruction, referred to as “vertical,” was compared with that of a modified femoral position, referred to as “horizontal,” which is lower than and anterior to an operative knee at 90° flexion. Two consecutive series of 50 patients underwent vertical and horizontal arthroscopic single-bundle ACL reconstruction, respectively. For vertical reconstruction, the clock position was chosen, placing the graft at 10:30 in right knees and 1:30 in left knees, 1 to 2 mm anterior to the posterior femoral cortical cortex and at the back of the resident ridge. In the horizontal reconstruction, the transplant replaced the original ligament insertion at approximately the 9:30 o’clock position in right knees and the 2:30 o’clock position in left knees, approximately 2 mm in front of the posterior femoral cortical cortex. One year after surgery, the results of stabilometric evaluation revealed good performance after horizontal transplant. The mean clinical results changed from 1.0 (±1.3) mm for vertical to 0.7 (±1.3) mm for horizontal reconstruction. [
Orthopedics.
2014; 37(5):321–324.]
Evaluation of the Cellular Origins of Heterotopic Ossification
Authors: Kan Lixin , Kessler John A.
Published: August 2014

Educational Objectives

As a result of reading this article, physicians should be able to:

1.

Update the current knowledge about candidate cell populations as heterotopic ossification (HO) contributors.

2.

Understand the potential limitations of the experimental designs and techniques underlying the identification of putative HO contributors.

3.

Clarify the confusion about the phenotypes of candidate populations in the literature.

4.

Contrast the fundamental cellular differences between HO and normal skeletogenesis to identify potential disease-specific targets.

Heterotopic ossification (HO), acquired or hereditary, is featured by the formation of bone outside of the normal skeleton. Typical acquired HO is a common, debilitating condition associated with traumatic events. Cardiovascular calcification, an atypical form of acquired HO, is prevalent and associated with high rates of cardiovascular mortality. Hereditary HO syndromes, such as fibrodysplasia ossificans progressiva and progressive osseous heteroplasia, are rare, progressive, life-threatening disorders. The cellular origins of HO remain elusive. Some bona fide contributing cell populations have been found through genetic lineage tracing and other experiments in vivo, and various other candidate populations have been proposed. Nevertheless, because of the difficulties in establishing cellular phenotypes in vivo and other confounding factors, the true identities of these populations are still uncertain. This review critically evaluates the accumulating data in the field. The major focus is on the candidate populations that may give rise to osteochondrogenic lineage cells directly, not the populations that may contribute to HO indirectly. This issue is important not solely because of the clinical implications, but also because it highlights the basic biological processes that govern bone formation. [
Orthopedics.
2014; 37(5):329–340.]
Deviation Analysis of Atlantoaxial Pedicle Screws Assisted by a Drill Template
Authors: Hu Yong , Yuan Zhen-Shan , Kepler Christopher K. , Albert Todd J. , Xie Hui , Yuan Jian-Bing , Dong Wei-Xin , Wang Cheng-Tao
Published: August 2014

Although C1–C2 pedicle screw fixation provides an excellent fusion rate and rigid fixation, this technique has a potential risk. It is essential to develop an accurate screwing method to avoid this neurovascular injury. To develop and validate the accuracy of a novel navigational template for C1–C2 pedicle screw placement in cadaveric specimens, computed tomography scans with 1-mm-wide cuts were obtained of 32 cadaveric cervical specimens. The authors developed 64 three-dimensional full-scale templates that were created by computer modeling with a rapid prototyping technique from the computed tomography data. Drill templates were constructed with a custom trajectory for each level and side. The drill templates were used to guide the establishment of a pilot hole for screw placement. The average distances between ideal and actual entry points of the C1 pedicle screws in the x, y, and z axes were 0.16±0.46 mm, 0.11±0.52 mm, and −0.01±0.54 mm, respectively, on the left side and 0.11±0.49 mm, 0.01±0.56 mm, and −0.09±0.59 mm, respectively, on the right side. The average distances between ideal and actual entry points of the C2 pedicle screws in the x, y, and z axes were 0.05±0.54 mm, 0.20±0.59 mm, and −0.06±0.58 mm, respectively, on the left side and 0.17±0.55 mm, 0.1±0.58 mm, and −0.01±0.49 mm, respectively, on the right side. Factors related to human error and imprecision are responsible for most malpositioning of instrumentation. The rapid prototyping drill template for C1–C2 screw placement is described to minimize human error, although it introduces error related to computer software and variation in manufacturing.
Bupivacaine for Pain Reduction After Iliac Crest Bone Graft Harvest
Authors: O’Neill Kevin R. , Lockney Dennis T. , Bible Jesse E. , Crosby Colin G. , Devin Clinton J.
Published: August 2014

Iliac crest bone graft remains the gold standard in achieving spinal arthrodesis, but chronic pain from graft harvest occurs in up to 39% of patients. Studies have shown that a single administration of local anesthetic reduces short-term pain, but they have not adequately investigated possible longer-term benefits. The goal of this study was to determine whether local administration of bupivacaine after iliac crest bone graft harvesting reduces pain and improves patient-reported outcomes. In this prospective, randomized, controlled, and blinded clinical study, 40 patients were identified who underwent posterior spine fusion with iliac crest bone graft and were randomized to receive either bupivacaine (treatment group, n=20) or saline (control group, n=20) at the iliac crest bone graft site. Pain at the harvest site was determined by a series of 12 visual and numeric pain scale assessments. Short Form-12 mental and physical component scores, EuroQol-5D, and Oswestry Disability Index assessments were made, along with determination of patient satisfaction and self-reported outcome of surgery. Baseline pain and outcome assessments were statistically similar (
P
>.05). Average pain scores were lower for all 12 assessments in the treatment group at mean follow-up of 5 weeks (significant differences in 6 assessments) and 20 weeks (significant differences in 2 assessments). No significant differences were found in Short Form-12 and EuroQol-5D scores. For patients who underwent lumbar fusion, the treatment group had significantly improved Oswestry Disability Index scores (mean±SD=10.8±7.1 vs 18.7±5.9,
P
=.012). Significantly more patients in the treatment group reported that surgery met all expectations (90% vs 50%,
P
=.016). This study is the 1st to show that a single administration of bupivacaine at the iliac crest bone graft harvest site during posterior spine fusion surgery can result in improved outcomes and reduced pain far beyond the anesthetic duration of activity.
Exposure of the Distal Humerus Using a Triceps Hemi-peel Approach
Authors: Grogan Brian F. , Blair James A. , Blease Robert E. , Cho Mickey S. , Hsu Joseph R.
Published: August 2014

This study evaluates the exposure of the distal humerus articular surface obtained using a triceps hemi-peel approach versus the triceps-flexor carpi ulnaris (TRIFCU) approach. Twelve cadaveric upper extremity specimens were dissected using a lateral-to-medial hemi-peel modification of the TRIFCU approach to the elbow. After completing the hemi-peel exposure, the visible border of the articular surface was marked with a permanent ink pen. The dissection was continued to complete a standard TRIFCU approach, and the visible border of the exposure was again marked. The elbow was disarticulated, and calibrated digital images were taken to quantify the humeral surface area exposed through each approach. During both approaches, the surgeon’s ability to visualize the intertrochlear groove, medial crista anterior crest, medial crista posterior crest, anterior capitulum, and posterior capitulum was recorded. No difference was found in the surgeons’ ability to identify the 5 designated anatomic landmarks using the hemi-peel versus the TRIFCU approach. The TRIFCU exposed an average of 6.68 cm
2
of the trochlear articular surface, whereas the hemi-peel approach exposed an average of 5.93 cm
2
. The average difference between the exposures was 0.75 cm
2
(
P
<.001), or 12.5%. The hemi-peel and TRIFCU approaches to the elbow both allow excellent visualization of the distal humerus articular surface. The hemi-peel exposure is a useful approach for the accurate reduction and fixation of displaced intra-articular distal humerus fractures.
Chondroblastoma of the Distal Phalanx
Authors: Gregory James R. , Lehman Thomas P. , White Jeremy R. , Fung Kar-Ming
Published: August 2014

Chondroblastoma is a rare, benign primary bone tumor that usually occurs at the epiphysis of long bones. The authors present an example of the diagnosis and successful treatment of this neoplasm in an exceedingly rare location in the distal phalanx. Clinical and radiographic outcomes after 68 months of follow-up are presented. A 15-year-old, right hand–dominant, boy developed painful swelling of the right ring finger. Radiographs revealed a radiolucent lesion of the distal phalanx with expansile remodeling of the bone. An excisional biopsy was performed with curettage and bone grafting of the lesion. The diagnosis of chondroblastoma was made based on pathologic evaluation of the biopsy specimen. Sixty-six months after surgical treatment, the patient was free of recurrence and metastatic disease with excellent clinical and functional outcomes. To the authors’ knowledge, this represents only the second reported case of chondroblastoma of the distal phalanx. The diagnosis of chondroblastoma in this rare location was made by pathologic review of the resection specimen. It is imperative to confirm the diagnosis of any resected bone specimen even when the concern for an aggressive or malignant lesion is low. A tumor presenting in an unusual location may require a change in treatment or surveillance.
The Transformational Role of Nursing in Health Care Reform
Authors: Sickora Cindy , Chase Sabrina Marie
Published: August 2014

Successful health care reform will require more than insuring 32 million additional Americans. It will demand that our expensive, hospital and provider–driven model of care adopt a community-driven wellness model that emphasizes disease prevention. Nursing is perfectly situated to lead this transformation. By educating students in ways that build on nursing’s legacy of health promotion and disease prevention, nurse educators can prepare nursing students to partner with underserved communities to offer low-cost, prevention-based services that meet local needs. This article uses preliminary data from the Jordan & Harris Community Health Center in Newark, New Jersey, to demonstrate how nurses can serve as role models in microsystem health care, while still following the Institute of Medicine’s recommendations for health care reform. [
J Nurs Educ
. 2014;53(5):277–280.]
Can Script Concordance Testing Be Used in Nursing Education to Accurately Assess Clinical Reasoning Skills?
Authors: Dawson Tyia , Comer Linda , Kossick Mark A. , Neubrander Judy
Published: August 2014

The Script Concordance Test (SCT) has been used successfully in medical schools to assess clinical reasoning in medical students, but it has not been widely used in nursing education. The purpose of this study was to provide additional evidence of the validity and reliability of the SCT in evaluating clinical reasoning in nursing students by replicating a previous study. The test was administered to 48 first-year Bachelor of Science in Nursing students. A scoring grid was developed using the aggregate scores method based on the modal responses of 13 panel members. The reliability of the scores was measured by Cronbach’s alpha coefficient, and the scores of the students and the panel were compared using a
t
test. The difference between the panel’s and the students’ scores was statistically significant, and the reliability of the scores is high. The SCT provides a reliable, standardized, and easy-to-administer method of evaluating clinical reasoning in nursing students. [
J Nurs Educ
. 2014;53(5):281–286.]
Congenital Nasolacrimal Duct Obstruction in Premature Children
Authors: Lorena Silvia Helena Tavares , Silva João Amaro Ferrari , Scarpi Marinho Jorge
Published: August 2014

Purpose:

To determine the incidence of congenital nasolacrimal duct obstruction (CNLDO) in premature and full-term children.

Methods:

Medical records of 200 premature and 200 full-term children from July 2004 to November 2009 at the Peri-Peri Health Center were retrospectively reviewed. Fifty-three nasolacrimal ducts in 32 premature children (21 patients were bilateral) and 9 nasolacrimal ducts in 7 full-term children (2 patients were bilateral) diagnosed as having CNLDO were retrospectively examined.

Results:

Of the 200 premature children, 32 (16%) had CNLDO compared with 7 (3.5%) of the 200 full-term infants (
P
< .0001). Thirty premature infants and five full-term children underwent conservative treatment. Bilateral obstruction was found in all 3 extremely premature children (gestational age < 28 weeks), in 9 (69.23%) moderately premature children (gestational age of 28 to 31 weeks), in 9 (56.25%) mildly premature children (gestational age of 32 to 36 weeks), and in 2 (28.57%) full-term children (gestational age > 37 weeks).

Conclusions:

This study reported a higher incidence of CNLDO in preterm infants when compared to full-term infants. This might be expected in light of the normal development of the nasolacrimal duct system, the patency of which normally occurs after the preterm infant is born.

[J Pediatr Ophthalmol Strabismus 2013;50(4):239–244.]