bluuebunny/crossref_metadata_2025 huggingface dataset:
Resorbable Materials and Composites: New Concepts in Orthopedic Biomaterials
Authors: Parsons J Russell
Published: April 2021

ABSTRACT: For the last several decades, research in orthopedic biomaterials has remained focused on homogeneous plastics and metals. Initial research resulted in rapid improvements and a number of standardized materials emerged. With time, development of these materials has become a slower, more deliberate process. Recently, however, investigators have sought to broaden the scope of orthopedic biomaterials research. New materials systems are now under consideration. These systems include natural and synthetic resorbable polymeries and resorbable ceramics. A variety of composite materials are under primary investigation or in clinical trials. Our emerging understanding of these new materials is rapidly leading to new surgical applications not possible with conventional metals and plastics.
The Use of Quadratus Femoris Muscle Pedicle Bone Graft for the Treatment of Displaced Femoral Neck Fractures
Authors: Morwessel Rosemarie , Evarts C McCollister
Published: April 2021

ABSTRACT: In 1974, Meyers et al advocated the use of the quadratus femoris muscle pedicle bone graft with screw fixation to treat displaced femoral neck fractures. In 1979 he quoted a 95% union rate in 144 patients and a 5% incidence of late segmental collapse. Most authors quote a 60% to 80% union rate and a 25% to 30% incidence of late segmental collapse of the femoral head.

From 1974 to 1980 at the University of Rochester, there were 13 patients, ages 20 to 60 years, who underwent the Meyers procedure for displaced femoral neck fractures. Twelve patients were done acutely and one was delayed. Followup averaged 38 months. Average time to bony union was five months. One patient had a nonunion secondary to inadequate fixation. Four patients showed radiographic evidence of late segmental collapse despite fracture union. These patients were between 20 and 28 years old. They had moderate to severe symptoms including pain, limitation of motion, and a limp Subsequently two of them had total hip replacements and one a valgus osteotomy.

To date few if any reports have reaffirmed the results obtained by Meyers et al. Although our series is small, the rate of union was 85% and the rate of late segmental collapse was 23%. These results are the same as or worse than those achieved by several authors using internal fixation alone or in combination with autogenous bone graft.
Idiopathic Chondrolysis of the Hip: An Ultrastructural Study of the Articular Cartilage of the Femoral Head
Authors: Ippolito Ernesto , Bellocci M , Santori F S , Ghera S
Published: April 2021

ABSTRACT: Core biopsies obtained from the articular cartilage of the femoral head of a 16-year-old girl with idiopathic chondrolysis of the hip were subjected to an ultrastructural study. Zone I was missing and zone II was the most superficial layer present in the articular cartilage of our patient. Collagen fibrils were thinner than normal and more uniform in diameter, and proteoglycans were normally distributed among them. Degenerating chondrocytes were found, as well as debris of dead cells, but many chondrocytes were still vital and engaged in active synthesis. Most of the chronic degenerative changes observed in ultrastructural studies on osteoarthritis were not observed in this case of idiopathic chondrolysis which seems to be, on the basis of our findings, a pathological process which develops and runs its course very quickly.
Congenital Radioulnar Synostosis
Authors: Okrent David H , McFadden John C
Published: April 2021

RADIOLOGIC CASE STUDY
Nine-Year Functional Nonunion of a Femoral Neck Stress Fracture: Treatment With Internal Fixation and Fibular Graft: A Case Report
Authors: Snyder Stephen J , Sherman Orrin H , Hattendorf Kurt
Published: April 2021

ABSTRACT: Open reduction and internal fixation utilizing a full thickness fibular graft was performed on a patient who presented with a 9-year-old functional nonunion of a femoral neck stress fracture. During this period, the patient had remained fully ambulatory, with intermittent episodes of hip pain. Our experience indicates that the treatment of old, nonunited stress fractures of the femoral neck with a fibular bone graft and internal fixation contributes to a successful result, lending support while stimulating osteogenesis as the nonunion heals. Use of rigid internal fixation will eliminate motion at the site of the fracture, enhancing incorporation of the bone graft and, thereby, speeding the patient's recovery.
Evaluation and Operative Procedures for Hallux Valgus Deformity
Authors: Bordelon R Luke
Published: April 2021

ABSTRACT: The hallux valgus deformity, or bunion deformity, is a common problem. Evaluation of the deformity for surgical intervention requires a knowledge of the basic pathomechanics of the medial displacement of the head out of the sesamoid complex with the associated deformity of the large toe and incompetency of the metatarsal cuneiform joint. The foot's relation to the leg and the body must be evaluated as well as the general condition of the patient, the age of the patient, and the expectations of the patient in regard to footwear and level of activity desired postoperatively. X-rays of the feet must be made in a consistent manner. The deformity should be classified as to the degree of severity. Operative procedures are grouped into the distal soft tissue procedures, metatarsal osteotomies, miscellaneous procedures, arthroplasty operations, and combinations of procedures. Indications and complications are presented. The procedures are discussed to provide an overview of surgical methods of treatment available for the hallux valgus deformity.
Regional Anesthesia for Ambulatory Foot and Ankle Surgery
Authors: Beskin James L , Baxter Donald E
Published: April 2021

ABSTRACT: Regional anesthesia provides significant advantages for the patient and practitioner involved in ambulatory foot and ankle surgery. Reliable techniques for administering regional ankle blocks emphasizing their importance in the practice of ambulatory surgery are presented.
A Technique for Studying the Kinematics of Human Joints: Part I: Theory
Authors: Ohwovoriole Ejovo N
Published: April 2021

ABSTRACT: A novel analytical method that allows iterative synthesis and analysis of the structure and physiology of human joints from a kinematic viewpoint is presented. The technique may be used for both anatomical and physiological joints. The joints are modeled as contacting rigid bodies connected by muscles and ligaments. The muscles and ligaments are regarded as flexible connections, either connecting the articulating bones or acting across the joints. A taut ligament or muscle is converted to a constraining force on the moving bone and used with the geometry of the bone in determining the degrees of freedom of the joint. The method uses a unique approach of measuring coordinates of points from a coordinate system local to each bone to avoid compounding errors. It is shown how these could then be used with the measured or estimated maximum lengths of the flexible connections to predict such kinematic joint properties as type, mobility, and range of motion in an iterative manner.
A Technique for Studying the Kinematics of Human Joints: Part II: The Humeroscapular Joint
Authors: Ohwovoriole Ejovo N , Mekow Craig
Published: April 2021

ABSTRACT: The humeroscapular joint is used as an example to illustrate some aspects of an analytical technique for studying the kinematics of human joints. Coordinates of attachment points for muscles and ligaments on the humerus and scapula of a human skeleton were measured on an automated coordinate measuring machine. Coordinates of points on the contact areas between the glenoid cavity and the humeral head were measured to determine and ensure the sphericity of the joint. Muscle and ligament lengths were also measured on a cadaver of similar dimensions to the skeleton. The data were then used to determine the range of motion of the humeroscapular joint by considering the intersections of spheres mapped onto a plane. It is shown that the glenohumeral ligament limits flexion while the coracohumeral ligament and supraspinatus muscle limit abduction. It is also shown that the coracoacromial ligament does not limit the motion of the humerus before the scapula gets involved in the motion of the shoulder complex.
Urinary Tract Sequelae: Possible Influence on Joint Infections Following Total Joint Replacement
Authors: Ritter Merrill A , Fechtman Robert W
Published: April 2021

ABSTRACT: A total of 277 patients receiving 364 total joint replacements in a period of 2 years were analyzed to determine whether urinary tract sequelae (infections, catheterization, and genitourinary instrumentation) encountered preoperatively or perioperatively had any significant influence on the development of postoperative joint infections. Three of these patients developed joint injections, none as a result of urinary tract infection. None of these infected patients required any catheterizations or instrumentation of the genitourinary system postoperatively. To enchance the previous data, all joint infections encountered in a period of 16 years were analyzed using the same criteria. Only one infection spread hematogenously from a urinary tract infection, and this occurred 20 months after surgery.

The results of this study show no correlation between preoperative or perioperative urinary tract sequelae and postoperative joint infections. Bacteriuria should not be considered a contraindication for total joint replacement.
Biomechanical Analysis of Stability and Fixation Strength of Total Shoulder Prostheses
Authors: Fukuda Kimitaka , Chen Chang-Ming , Cofield Robert H , Chao Edmund Y S
Published: April 2021

ABSTRACT: The Neer I (polyethylene glenoid), Neer Il (plastic glenoid surface with metal backing), Cofield, and Gristina monospherica! total shoulder prostheses were tested for joint subluxation resistance and glenoid component fixation strength. Synthetic glenoid models with consistent structural properties and standard under-cutting geometry were used for glenoid component fixation with bone cement. It was found that joint subluxation resistance varied linearly with axial compressive force applied. Higher subluxation strength was associateci with the amount of curvature of the glenoid articulating surface. Consequently, joint stability was consistently higher for the Gristina design, and all had lower resistance in the anteroposterior direction. After complete joint dislocation under high axial compressive force, the polyethylene material at the site of subluxation experienced gross plastic deformation. The fixation strength of the glenoid component was lowest for the Neer I design and highest for the Cofield design. Fatigue loading at the joint did not seem to affect the glenoid component fixation strength. In general, all glenoid components appeared to have sufficient fixation strength against normal shoulder joint forces except the Neer I design. Loosening and fracture of the plastic glenoid component may occur under excessive loads.
The Intertrochanteric Hip Fracture: A Retrospective Analysis
Authors: Steinberg Gerald G , Desai Sanjay S , Kornwitz Norman A , Sullivan Thomas J
Published: April 2021

ABSTRACT: One hundred intertrochanteric hip fractures were analyzed utilizing a computerassisted digitization system to study the factors affecting postoperative stability. Fractures were evaluated by measuring shortening and angulation, collapse of telescoping device when utilized, and migration of the fixation device within the femoral head. Fractures were classified preoperativefy according to their stability and postoperatively according to the type of operative reduction performed. The failure rate and postoperative stability were then compared according to the type of fracture, type of operative reduction, and internal fixation device utilized. Results indicate that the preoperative fracture classification is a strong and significant determinant of postoperative stability. Conversely, the type of operative reduction was not as significant a determinant of postoperative stability. In particular, medial displacement osteotomy had no advantage over anatomic reduction in the unstable fracture. The use of a fixed angle nail plate was associated with an increased failure rate.
Osteoporotic Correlates of Alcoholism in Young Males
Authors: Harding Amanda , Dunlap James , Cook Stephen , Mattalino Angelo , Azar Frederick , O'Brien Michael , Kester Marcus
Published: April 2021

ABSTRACT: A group of 22 white males (ages, 28 to 40 years) with histories of chronic alcohol abuse ranging from 1 to 21 years were evaluated for trabecular bone mineral density in the left femoral neck area. A group of age and weightmatched white males with no history of alcoholism served as controls. All participants completed medical history questionnaires regarding fracture history, dietary habits, medications, and physical activity. Singh femoral trabecular indices also were measured for the alcoholic participants.1 Analysis of bone mineral data as measured by dual photon absorptiometry revealed no statistically significant reduction in the bone mineral densities of the alcoholic group when compared to the controls. No differences were seen in the areas of the femoral neck, Ward's triangle, and greater trochanter. Duration of alcoholism also was not correlated with the degree of osteopenia. Singh index measurements of right and left femoral heads were compared and revealed no significant differences within individual patients.1 Left femoral Singh index values averaged 5.5 (range, 4 to 6) for the alcoholic group and were not indicative of decreased bone mineral density.1 It is concluded from this study that chronic alcoholism associated with heavy smoking most likely has a debilitating effect on the trabecular bone density of white males, yet clinical and radiographic evidence is not widely manifested in men under the age of 40 years.
Total Articular Replacement Arthroplasty
Authors: Cohn Bruce T , Froimson Avrum I , Brahms Malcolm A , Greenwald A Seth
Published: April 2021

ABSTRACT: Surface replacement, popularized in the early 1970s has fallen into disfavor by much of the orthopedic community. To date, the authors' experience with 29 cemented total articular replacement arthroplasties (TARAs) in 25 patients has been quite favorable. Factors associated with these favorable results include: a physiologic age less than 60, good bone quality, viability of the remaining femoral head, and preservation of the acetabular subchondral plate. The mean age of cases in this study was 52 years, with patient follow up ranging between 3.5 and 7 years; there were two failures. Today, although conventional cementless total hip arthroplasty seems to be in vogue, real and potential problems exist. These concerns, in conjunction with the good results reported in this series, should encourage the orthopedic surgeon to take a second look at resurfacing arthroplasty, especially in the select group of patients defined in this article. Pending the long-term results of non-cemented prostheses the surgeon may even consider using cementless TARA components.
Freiberg Disease Complicating Unrelated Trauma
Authors: Binek Robert , Levinsohn E Mark , Bersani Frank , Rubenstein Harold
Published: April 2021

ABSTRACT: Freiberg's infraction is an avascular necrosis of the metatarsal head characterized by the development of disorderliness of chondrogenesis and osteogenesis in previously normal bone. Radiographic findings follow the pathological progression of bony changes. The presented cases document the development of avascular necrosis in a previously normal metatarsal that occurred after trauma or surgery elsewhere in the foot, it is suggested that infraction of the metatarsal head resulted from microfracture caused by abnormal stress.
Radiographic Distortion of Bones: A Marker Study
Authors: Stevens Peter M
Published: April 2021

ABSTRACT: The osseous shadows observed on radiographs are distorted by parallax and magnification error. Parallax may be minimized by proper centering of the subject; magnification error is governed by the subject-to-cassette and exposure distances. The usual assumption that radiographic magnification is 15% is, therefore, erroneous and misleading. A triangular marker was used to assess radiographic distortion of bones on films exposed at "standard" distances of 40 and 72 inches, varying the subject-to-cassette distance to simulate the effect of positioning problems posed by body habitus or joint contracture. Osseous magnification ranged from 6% to 36% on the 40-in exposures and from 3% to 17.5% at 72 in. Using a mid-sagittal marker, true bone size can be more closely determined; once the magnification is known, linear measurements can be normalized for accuracy, permitting valid comparison of quantitative data. Preoperative planning of reconstructive procedures, including implant sizing with templates, is greatly facilitated.
Fractures of the Femoral Neck Treated With Cemented Bipolar Hemiarthroplasty
Authors: Eiskjær Søren , Gelineck John , Søballe Kjeld
Published: April 2021

ABSTRACT: Seven of 59 (12%) bipolar hemiarthroplasties for displaced femoral neck fracture were classified as failures at the 3-year follow-up examination. Two prostheses dislocated, 4 had loose femoral stems, and 1 was revised to a total hip arthroplasty because of pain. No patients developed acetabular erosion or deep infection. Only four of 15 patients examined by fluoroscopy shared movement between outer metal/cartilage and inner metal/ polyethylene surfaces. All movement occurred at the outer metal/cartilage surface in the remaining nine patients. We conclude that the low failure rate, which compares favorably with the best results after internal fixation, is caused by the optimal selection of patients for this operation (high age, low activity level) and the use of bone cement. The bipolar design is less important, since most of these prostheses function as ordinary unipolar prostheses after some time.
Economies of Scale, Physician Volume for Orthopedic Surgical Patients, and the DRG Prospective Payment System
Authors: Munoz Eric , Boiardo Richard , Mulloy Katherine , Goldstein Jonathan , Brewster Jeffrey G , Tenenbaum Noel , Wise Leslie
Published: April 2021

ABSTRACT: American hospitals face increasing constraints due to a variety of factors. Federal and state diagnostic-related group (DRG) prospective hospital pricing has caused tremendous fiscal pressure on hospitals; many face substantial financial deficits. We analyzed the volume of orthopedic surgical procedures performed by an individual orthopedic surgeon for all patients (N = 2, 134) treated for a 3-year period at a large academic medical center; these surgeons were arbitrarily divided into low volume or high volume. Patients of low volume surgeons had a longer hospital length of stay and hospital cost (after correction for DRG case mix and severity of illness), greater financial risk under DRGs, and a poorer outcome, compared with patients of higher volume orthopedic surgeons. Pearson correlation showed an inverse relationship between cost per patient and physician volume for nonemergency patients -0.201 (P<.0001), and emergency patients, -0.321 (P<.0001 ). Although the reasons for these findings appeared multifactoral, they raise important issues related to orthopedic surgical hospital costs, access, and quality of care. In addition, they suggest that hospital cost for these patients (and perhaps outcome) may be related to orthopedic surgical volume, and that DRG hospital payment (on the margin) may affect future orthopedic surgical practice opportunities.
Oral Ciprofloxacin for Osteomyelitis
Authors: MacGregor Rob Roy , Graziani Amy L , Bsterhai John L
Published: April 2021

ABSTRACT: Ciprofloxacin is a new, oral, broad spectrum fluoroquinolone antibiotic which has a long serum half-life, a low incidence of significant adverse reactions, and is administered twice daily. Eighteen patients with osteomyelitis were treated with ciprofloxacin, 750 mg orally twice daily. The mean age of the patients was 43 years (range, 21 to 73 years); 12 were men. The duration of treatment ranged from 5 to 52 weeks (mean, 20.0±15.7 weeks). At follow up (mean, 18±8.5 months; range, 4 to 34.5 months), 11 patients (61.6%) achieved arrest of infection, 4 (22.2%) had improved with therapy, and 3 (16.6%) failed to improve. Ciprofloxacin was well tolerated. Four case histories are given.
PROGRESSIVE DIAPHYSEAL DYSPLASIA: CASE REPORT AND LITERATURE REVIEW
Authors: Aggarwal Praveen , Wali Jyoti P , Sharma Surender K
Published: April 2021

ABSTRACT

We describe a case of progressive diaphyseal dysplasia occurring sporadically in a 25year-old woman. This patient had monorrhagia, and severe anemia and hepatosplenomegaly, unusual clinical features of this disease.
ANALYSIS OF THE DISCOID MENISCUS IN KOREANS
Authors: Seong Sang Cheol , Park Min Jong
Published: April 2021

ABSTRACT

Discoid meniscus is a relatively common disorder of the knee in Koreans. Its arthroscopic treatment is one of the most technically demanding procedures of this field. The purposes of this study were to define the clinical features of the discoid meniscus in Koreans and to suggest an adequate arthroscopic technique. We performed arthroscopic meniscectomy on 37 knees with a lateral discoid meniscus. The average length of follow up was 21 months. The presence of synovial hypertrophy in the knee with discoid was significantly higher than that with a non-discoid meniscal lesion. A medial midpatellar portal for the arthroscope is advisable for clean arthroscopic surgery in this situation. We obtained satisfactory results through the partial resection of the discoid meniscus, leaving the normal semilunar-shaped meniscus intact as much as possible.
EVALUATION, PROGNOSIS, AND MEDICAL TREATMENT CONSIDERATIONS OF METASTATIC BONE TUMORS
Authors: Brage Michael E , Simon Michael A
Published: April 2021

ABSTRACT

Metastatic cancer can cause severe pain and disability. Metastases can occur in any bone, but usually are located in the axial or proximal appendicular skeleton. The most frequently encountered primary tumors that spread to bone are those of the prostate, breast, kidney, lung, and thyroid. When the origin of the primary cancer is known, skeletal metastases are more often from breast or prostate. When the primary site is unknown, the lung and kidney should be suspected as sites of origin. The nonoperative management of skeletal metastases from multiple myeloma and from carcinomas of the prostate, breast, kidney, lung, and thyroid are discussed.
TREATMENT OF UNUNITED TIBIAL FRACTURES: A COMPARISON OF SURGERY AND PULSED ELECTROMAGNETIC FIELDS (PEMF)
Authors: Gossling Harry R , Bernstein Richard A , Abbott Joan
Published: April 2021

ABSTRACT

The use of pulsed electromagnetic fields (PEMF) is gaining acceptance for the treatment of ununited fractures. The results of 44 articles published in the English language literature have been compiled to assess the effectiveness of PEMF vs surgical therapy. For ununited tibial fractures, 81% of reported cases healed with PEMF vs 82% with surgery. After multiple failed surgeries, the success rate of PEMF is reported to be greater than with surgery; this discrepancy increases with additional numbers of prior surgeries. In infected nonunions, the results of surgical treatment decreased by 21% and were less than the results utilizing PEMF (69% vs 81%). In open fractures, surgical healing exceeded PEMF (89% vs 78%), whereas in closed injuries PEMF cases healed more frequently (85% vs 79%). In general, PEMF treatment of ununited fractures has proved to be more successful than noninvasive traditional management and at least as effective as surgical therapies. Given the costs and potential dangers of surgery, PEMF should be considered an effective alternative. Experience supports its role as a successful method of treatment for ununited fractures of the tibia.
EVALUATION OF THE DEGREE OF EFFECTIVENESS OF BIOBEAM LOW LEVEL NARROW BAND LIGHT ON THE TREATMENT OF SKIN ULCERS AND DELAYED POSTOPERATIVE WOUND HEALING
Authors: Iusim M , Kimchy J , Pillar T , Mendes D G
Published: April 2021

ABSTRACT

Twenty-one patients with 31 postoperative delayed open wounds resistant to conventional therapy were randomly allocated to three groups. Group 1 was treated with red low level narrow band (LLNB) light (660 nm); group 2 was treated with infrared LLNB light (940 nm); and group 3 was treated with a placebo such as the Biobeam machine (no light irradiation). Group 1 showed a significant improvement compared to groups 2 and 3 (t-test).
ENERGY DEMANDS FOR WALKING IN DYSVASCULAR AMPUTEES AS RELATED TO THE LEVEL OF AMPUTATION
Authors: Pinzur Michael S , Gold Julia , Schwartz David , Gross Nicholas
Published: April 2021

ABSTRACT

Cardiac function and oxygen consumption were measured in 25 patients who underwent amputation for peripheral vascular disease (PVD), and in five similarly aged control patients with PVD. Five patients at each of the midfoot, Syme's, below-, through-, and above-knee amputation levels and the five controls were measured at rest, normal walking speed, and maximum walking speed on a treadmill. At normal walking speed, all of the patients functioned at approximately 80% of their cardiac capacity. Normal walking speed and cadence decreased and oxygen consumption per meter walked increased with more proximal amputation. The ratio of cardiac function and oxygen consumption at normal walking speed as compared with at rest increased with more proximal amputation, and the capacity to increase walking speed and oxygen consumption lessened. Our results suggest that peripheral vascular insufficiency amputees function at a level approaching their maximum functional capacity. At more proximal amputation levels, the capacity to walk short or long distances is greatly impaired.
CUMULATIVE TRAUMA DISORDERS
Authors: Schwartz Robert G
Published: April 2021

ABSTRACT

Cumulative trauma disorders have increased five-fold since 1979 and now account for up to 47% of workplace injuries. Nerve entrapment, tendonitis, and other soft tissue injuries are the most common diagnostic groups. Both occupational and non-occupational factors contribute to the etiology of these disorders. Epidemiology, differential diagnosis, and interventions for treatment are reviewed.
THE EFFECT OF POSTOPERATIVE WOUND DRAINAGE REINFUSION IN REDUCING THE NEED FOR BLOOD TRANSFUSIONS IN ELECTIVE TOTAL JOINT ARTHROPLASTY: A PROSPECTIVE, RANDOMIZED STUDY
Authors: Simpson Michael B , Murphy Kevin P , Chambers Henry G , Bucknell Allan L
Published: April 2021

ABSTRACT

A prospective, randomized study was conducted in 24 patients using the Solcotrans Orthopaedic Drainage Reinfusion System (Smith & Nephew Richards Ine, Memphis, Tenn) for postoperative blood salvage in total joint arthroplasty. The amount of postoperative autologous blood salvage averaged 946 mL. Only 25% of the study group required postoperative transfusions, compared to 83% of the control group (P =.016). In total knee arthroplasties, only 11% of the study group required transfusions, compared to 78% of the control group (P=. 018). There were no transfusion reactions, infectious complications, or coagulopathies. Postoperative blood salvage is a safe, reliable, and effective source of autologous blood.
PRIMARY BONE TUMORS OF THE SPINE: A SURVEY OF THE EVALUATION AND TREATMENT AT THE ISTITUTO ORTOPEDICO RIZZOLI
Authors: Boriani S , Biagini R , De Iure F , Andreoli I , Campanacci L , Di Fiore M , Zanoni A
Published: April 2021

ABSTRACT

The experience at Istituto Rizzoli with 366 primary bone tumors of the spine focuses on the criteria for planning and treatment. An accurate preoperative evaluation by standard radiograph, computerized tomography scan, and magnetic resonance imaging allow the classification of benign lesions as latent (not requiring treatment), active (curettage), or aggressive (curettage plus adjuvants or marginal resection). The malignant lesions are classified as intracompartmental or extracompartmental (both low and high grade). Wide resection is attempted, but seldom is feasible. An angiographic study of the spinal cord is compulsory for lesions located in the thoracolumbar region. The value of embolization is enhanced, primarily in highly vascular lesions. An accurate preoperative study of the vital parameters of the patient, together with a continuous intraoperative monitoring, is mandatory.
THE EFFECTIVENESS OF CUT-PROOF GLOVE LINERS: CUT AND PUNCTURE RESISTANCE, DEXTERITY, AND SENSIBILITY
Authors: Salkin Jeffrey A , Stuchin Steven A , Kummer Frederick J , Reininger Rhonda
Published: April 2021

ABSTRACT

Five types of commercial glove liners (within double latex gloves) were compared to single and double latex gloves for cut and puncture resistance and for relative manual dexterity and degree of sensibility. An apparatus was constructed to test glove-pseudofinger constructs in either a cutting or puncture mode. Cutting forces, cutting speed, and type of blade (serrated or scalpel blade) were varied and the time to cut-through measured by an electrical conductivity circuit. Penetration forces were similarly determined with a scalpel blade and a suture needle using a spring scale loading apparatus. Dexterity was measured with an object placement task among a group of orthopedic surgeons. Sensibility was assessed with Semmes-Weinstein monofilaments, two-point discrimination, and vibrametry using standard techniques and rating scales. A subjective evaluation was performed at the end of testing. Time to cut-through for the liners ranged from 2 to 30 seconds for a rapid oscillating scalpel and 4 to 40 seconds for a rapid oscillating serrated knife under minimal loads. When a 1 kg load was added, times to cut-through ranged from 0.4 to 1.0 second. In most cases, the liners were superior to double latex. On average, 100% more force was required to penetrate the liners with a scalpel and 50% more force was required to penetrate the liners with a suture needle compared to double latex. Object placement task times were not significantly longer for subjects wearing liners compared to double latex gloves. Semmes-Weinstein monofilaments, two-point discrimination, and vibrametry showed no difference in sensibility among the various liners and double latex gloves. Subjects felt that the liners were minimally to moderately impairing. An acclimation period may be required for their effective use.
ASSESSMENT OF PATELLAR HEIGHT AFTER AUTOGENOUS PATELLAR TENDON ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Shelbourne K Donald , Rubinstein Richard A , Braeckel Cynthia J , Butler Jack P
Published: April 2021

ABSTRACT

In this study, we sought to determine if a significant change in patellar height occurs after autogenous patellar tendon anterior cruciate ligament (ACL) reconstruction at our clinic. In a series of 71 patients (52 males and 18 females; average age: 22 years; range: 12 to 41) randomly selected, all had undergone an identical autogenous patellar tendon ACL reconstruction, by the same surgeon, and followed the same postoperative accelerated rehabilitation program. All patients bad standardized preoperative and postoperative lateral knee radiographs. The patellar tendon length as well as the patellar height and ratio of Blackburne and Peel were measured by the same person for all subjects. The length of the patellar tendon shortened by an average of 0.4 mm (range: 6% lengthening to 12% shortening) which is less than 1% and not statistically significant (P=.068). The Blackburne and Peel ratio for patellar height decreased by 1%, which was also not statistically significant (P=.060). The evidence obtained from this study indicated no significant change in patellar height after autogenous patellar tendon ACL reconstruction combined with postoperative accelerated rehabilitation and no correlations with postoperative complications, secondary surgeries, timing of surgery, age, or anterior knee symptoms.
Measurement of Bone Mineral Density in Osteoporotic Fractures of the Spine Using Dual Energy X-Ray Absorptiometry
Authors: Jahng Jun Seop , Lee Weon Ik
Published: April 2021

ABSTRACT

The authors analyzed bone mineral density (BMD) in 283 postmenopausal and senile women using dual energy x-ray absorptiometry from March 1990 to April 1 992. Bone mineral density of the vertebral body in the osteoporotic fracture group was compared with that in the osteoporotic group to investigate the correlation among BMD, age distribution, and fracture type, and to estimate fracture threshold in the osteoporotic fracture group. BMD decreased rapidly (10%) from 50 and 60 years of age and decreased slowly after 60 years of age; osteoporotic spine fractures were found in 98 cases (35%); there was significant difference in BMD between the osteoporotic group and osteoporotic fracture group; there was no spine fracture when BMD was above 1 .00 g/cm2; fracture threshold was 0.85 g/cm2 at the 90th percentile; BMD in multiple spine fracture and old fracture groups was lower than in the single and fresh fracture groups and this was statistically significant We have concluded that when BMD decreases to less than 0.85 g/cm2, the risk of osteoporotic vertebral fractures escalates rapidly. Postmenopausal and senile women with BMD less than this fracture threshold should receive prophylaxis for osteoporotic fracture.
Managing the Risk of Thrombosis in the Perioperative Period in Patients Undergoing Orthopedic and Trauma Surgery With Low-Molecular-Weight Heparin: Enoxaparin
Authors: Lassen Michael R , Borris Lars C
Published: April 2021

ABSTRACT

Patients undergoing arthroplastic surgery of the lower limbs and those with multiple injuries have a high risk of thromboembolism. Enoxaparin is a highly effective antithrombotic drug that is well tolerated and without the need for monitoring. Numerous controlled trials in these patient groups have demonstrated enoxaparin to be at least as effective as heparin in reducing the occurrence of deep vein thrombosis while showing a tendency towards lower risk of bleeding complications; therefore, enoxaparin is recommended as thromboprophylaxis in patients undergoing major hip or knee surgery or suffering from multiple trauma.
Management of Odontoid Fractures
Authors: Marchesi Dante G
Published: April 2021

Spinal Trauma
Assessment of Press-Fit Hip Femoral Components Retrieved at Autopsy
Authors: Lester D Kevin , Campbell Pat , Ehya Anoush , Rude Robert K
Published: April 2021

ABSTRACT

Eleven femurs with press-fit titanium hip components were retrieved at autopsy for clinical, radiographic, and histologic evaluation. Back-scattered electron microscopy (BEM), bone densitometry, and appositional bone index studies also were performed. The average patient age was 87 years; the average time in situ was 22 months (range: 2 to 60). All patients were functioning well and pain free. Radiographs and bone mineral density studies (BMD) showed mild proximal stress shielding in five cases. No cases of osteolysis or pedestal formation were observed. Histologic sections revealed an average of 26% bone-prosthesis contact. Bone surrounding the prosthesis appeared viable, and osteoclastic activity in the interfacial bone was minimal; the presence of macrophages and inflammatory cells was rare. The appositional bone index averaged 40%. Bone-prosthesis contact was seen consistently at the corners of the component in multiple regions, mostly where prosthesis-endosteal cortical contact was made. BEM demonstrated intimate contact of bone with the rough titanium surface. Bone mineral density was lower in the lesser trochanter and medial proximal regions of the implanted femur than in the contralateral femur. Evidence of bone on-growth fixation in 11 femoral components suggests that cementless, stable bone fixation may be achievable in senior individuals and that "complete fit and fill," porous-coated, cementless prostheses may not be required for prosthesis stability.
Referral Patterns of Hip Pain in Patients Undergoing Total Hip Replacement
Authors: Khan Noman Q , Woolson Steven T
Published: April 2021

ABSTRACT

This study was undertaken to determine the most common referral patterns of hip pain in patients scheduled to undergo primary and revision total hip replacement. The exact location of pain from the hip was recorded prospectively for 323 patients (358 hips) who had primary total hip replacement and for 94 patients who had revision of a loose total hip.

Seventy-three percent of patients with primary hip disease had pain in the grain, and 27% had groin pain that referred to the knee. Eighty-nine percent of 57 patients who had femoral component loosening had thigh or knee pain, and all of the 34 patients who had a loose acetabular component with a well-fixed femoral implant had pain in the hip region without distal radiation of pain.

These results indicate that in patients who have a painful total hip, thigh pain is highly suggestive of femoral component loosening and pain located around the hip region that does not radiate distally is associated with isolated acetabular component loosening.
Comparison of Plain Radiographs and CT Scans in Instrumented Posterior Lumbar Interbody Fusion
Authors: Siambanes David , Mather Steven
Published: April 2021

ABSTRACT

The success of posterior lumbar interbody fusion has been analyzed primarily by plain radiography. There are no widely accepted criteria for fusion, except for lack of motion, which can be obviated by instrumentation, and the appearance of continuous bridging bone in the interspace. To determine the accuracy of plain radiography in detecting posterior lumbar interbody union, the radiographs of instrumented posterior lumbar fusion performed at 22 levels were compared with reformatted computed tomography (CT) scans. Results revealed that although 17 of 22 interbody levels were classified as fused by radiograph, 10 of these 17 demonstrated a nonunion by reformatted CT scans taken an average of 13.8 months postoperatively. Only progressively increased density by radiograph correlated with a solid fusion by CT scan. We therefore conclude that plain radiographs are unreliable in reporting the results of posterior lumbar interbody fusion and that CT scanning may be more appropriate.
Comparison of Fixation Methods for Preventing Pelvic Ring Expansion
Authors: Vrahas M S , Wilson S C , Cummings P D , Paul E M
Published: April 2021

ABSTRACT

Several methods of external and internal fixation are used in urgent situations to lessen intrapelvic bleeding associated with unstable pelvic fractures. Pelvic stabilization limits pelvic expansion and thereby restricts the space for potential blood loss. This study compared several fixation methods using cadaveric pelves to determine which method best prevents pelvic expansion. Three methods of internal fixation and three methods of external fixation were compared. Anteroposterior fixation provided the greatest control against pelvic expansion; however, it is clinically impractical for emergency use. Therefore, external fixation provided the most reliable control of pelvic expansion in the emergency setting.
An Analysis of Hylamer and Polyethylene Bearings From Retrieved Acetabular Components
Authors: Collier John P , Bargmann Lauren S , Currier Barbara H , Mayor Michael B , Currier John H , Bargmann Brian C
Published: April 2021

ABSTRACT

Hylamer and conventional polyethylene acetabular liners of the same design, revised for a variety of reasons, were examined and compared to assess the performance of Hylamer as a bearing material. Clinical damage modes, linear wear rates, oxidation levels, and mechanical properties were measured. In both series, many liners were retrieved for dislocation. Wear/osteolysis was the most common reason for retrieval in the Hylamer series, while none of the conventional polyethylene liners were retrieved for this reason. Nearly all liners exhibited abrasion, burnishing, scratching, and creep. The Hylamer liners had more cracking, delamination, and pitting. The Hylamer liners had an average linear wear rate of 0.32 mm/year, while the conventional polyethylene liners had an average wear rate of 0.20 mm/year. Due to sample size, no statistical difference in wear rate was noted between the two groups.

In general, both the Hylamer and conventional polyethylene showed oxidation peaks subsurface, resulting from their exposure to gamma radiation in air. Liners with elevated oxidation had decreased ultimate tensile strength, elongation, and toughness. For given oxidation levels, the corresponding mechanical properties of Hylamer appeared lower than those of conventional polyethylene. The ultimate tensile strength values ranged from 14 to 33 MPa for Hylamer and 19 to 32 MPa for conventional polyethylene. Elongation ranges were 19% to 350% (Hylamer) and 80% to 375% (conventional).

The Hylamer retrievals in this study gave initial indications of performance; Hylamer appeared to behave similarly, but not superiorly, to conventional polyethylene, in the early functional period with respect to clinical wear and clinical performance. Both Hylamer and conventional polyethylene liners were degraded by gamma sterilization in air, with Hylamer liners demonstrating greater property changes.
Femoral Neck Fracture Fixation: A Biomechanical Study of Two Cannulated Screw Placement Techniques
Authors: Booth Kevin C , Donaldson Thomas K , Dai Qiang G
Published: April 2021

ABSTRACT

This biomechanical study evaluated two different methods of femoral neck fracture fixation. Ten pairs of embalmed femora were used. A standardized midcervical osteotomy was performed. One side from each pair was fixed with either conventional (central) or calcar (cortical adjacent) screw placement. The femora pairs then were subjected to cyclic and load to failure biomechanical testing. The results demonstrated significant improved stability, load, stiffness, and displacement in all tested parameters for the group with calcar screw fixation. Grossly, the conventional fixation group tended to fail in an excessively varus position, while the calcar fixation group failed with impaction of the head on the calcar, a potentially stable position.
Radiology of Skeletal Tuberculosis
Authors: Ridley N , Shaikh M I , Remedios D , Mitchell R
Published: April 2021

ABSTRACT

In recent years, the incidence of tuberculosis (TB) has increased, primarily in developing countries, but also in Europe and North America. The association between TB and human immunodeficiency virus infection is well-documented. In these cases, TB is more likely to be extrapulmonary. The spine is the most common site for skeletal TB. Atypical appearances may be present in immigrants. Plain radiography remains the cornerstone for imaging, but newer cross-sectional modalities such as computed tomography, ultrasonography, and magnetic resonance imaging are becoming increasingly valuable in early and accurate diagnosis. This article reviews the features of musculoskeletal TB and the role that imaging plays in diagnosis and management.
A Comparison of Plate and Pin Fixation for Arthrodesis of the Rheumatoid Wrist
Authors: Rehak David C , Kasper Paul , Baratz Mark E , Hagberg William C , McClain Edward , Imbriglia Joseph E
Published: April 2021

ABSTRACT

This restrospective study compared plate fixation versus pin fixation in 57 patients with rheumatoid arthritis who underwent wrist arthrodesis. Fixation was achieved by using plates in 32 patients and longitudinal pins in 25 patients. Clinical follow-up averaged 29 months (range: 12-57 months) and radiographic follow-up averaged 16 months (range: 12-39 months). Union occurred in 97% of the wrists fixed with plates and in 96% of the wrists fixed with pins. There were 6 (19%) complications in the plate group and 7 (28%) complications in the pin group. Three (12%) wrists fixed with pins moved from the immediate postoperative position to a position of relative volar flexion, while radiographs showed no changes in wrist position in the plate group. With both methods, successful arthrodesis stabilized the wrist in a high percentage of patients. Plate fixation offers an excellent alternative method for arthrodesis of the rheumatoid wrist.
Custom 95° Condylar Blade Plate for Pediatric Subtrochanteric Femur Fractures
Authors: Segal Lee S
Published: April 2021

ABSTRACT

Subtrochanteric fractures in the older child and adolescent often are not amenable to conservative methods of treatment. The anatomic constraints of the proximal femur including the small diameter of the femoral neck and the presence of the capital femoral physis may limit the type of internal fixation used in these patients. This article presents our preliminary experience with a custom 95° condylar blade plate for subtrochanteric fractures in older children and adolescents.
Posterior Stabilization of Unstable Sacroiliac Injuries With the Texas Scottish Rite Hospital Spinal Instrumentation
Authors: Korovessis Panagiotis , Stamatakis Marios , Baikousis Andreas
Published: April 2021

ABSTRACT

This article describes a new alternative technique for stabilization of unstable sacroiliac injuries using the Texas Scottish Rite Hospital (TSRH) Instrumentation. The TSRH instrumentation was applied in 14 consecutive patients with unstable posterior pelvic ring disruptions. All patients underwent follow-up for an average of 29 months. Clinical results, using the rating system of d'Aubigne, were good in 9 and satisfactory in 5 patients. No pressure sores, infection, significant loss of correction, or hardware failures were observed postoperatively. The use of the TSRH instrumentation for stabilization of sacroiliac injuries offered sufficient stabilization of the posterior pelvic ring and permitted early mobilization without loss of correction.
Surgical Treatment of Comminuted Intra-Articular Fractures of the Distal Humerus With Double Tension Band Osteosynthesis
Authors: Zhao Jie , Wang Xinwei , Zhang Qiulin
Published: April 2021

ABSTRACT

Intra-articular fractures of the distal humerus are usually treated with cancellous screws for the condylar metaphysis itself and two Y-shaped plates for fixation of the metaphysis to the shaft. Twenty-four patients with comminuted intra-articular fractures (class C on AO/ASIF classification) were treated with crossed K-wires for the condylar metaphysis and double tension band osteosynthesis for fixation of the metaphysis block to the shaft. Excellent or good results were achieved in 83% of patients. This technique is easier to perform and more cost effective than most other fixation methods. Additionally, it offers good stability and allows for earlier functioning of the elbow. Complication rates are comparable to other methods of internal fixation.
Early Results of Isoelastic Hemiarthroplasty in Chronic Shoulder Arthritis
Authors: Sait Suhaib , Scott William A
Published: April 2021

ABSTRACT

Fourteen isoelastic shoulder hemiarthroplasties were studied in patients with shoulder pain due to chronic rheumatoid arthritis and osteoarthritis unresponsive to conservative means. The average follow-up was 27 months (range: 12-46 months) and the average patient age was 66.4 years (range: 54-79 years).

A Constant shoulder score was used to assess results. Pain relief was obtained in 85.7% of patients. Function scores averaged 8 preoperatively and 13 postoperatively. Subjectively, 1 2 patients improved. Average gain was 33° of abduction, 35° of flexion, and 21° of external rotation. Internal rotation improved by two levels on the spine. Total shoulder scores improved from an average of 42 points preoperatively to 7$ points postoperatively. There was 1 complication of immediate postoperative dislocation.

Early results with isoelastic (polyacetyl resin) shoulder hemiarthroplasty are encouraging. The prosthesis is inexpensive and easy to use, requires minimal bone resection, involves cementless fixation, and has established results in tumor surgery. Its long-term value for chronic arthritis will be reported as part of an ongoing prospective study.