bluuebunny/crossref_metadata_2025 huggingface dataset:
Bone and Soft Tissue Tumours of the Foot: Review of 83 Cases
Authors: Kinoshita G , Matsumoto M , Maruoka T , Shiraki T , Tsunemi K , Futani H , Maruo S
Published: October 2016

Purpose.

To review cases of bone and soft tissue tumours of the feet managed at the Hyogo College of Medicine, Nishinomiya and Takarazuka Municipal Hospital, Takarazuka, Japan.

Methods.

Retrospective analysis of 83 patient records treated for bone and soft tissue tumours of the feet between 1974 and 2000.

Results.

There were 33 benign bone tumours, one primary malignant bone tumour, and 2 metastatic bone cancer. Marginal resection was performed in cases of osteochondroma and curettage in cases of other benign bone tumour. Despite below-knee amputation in the case of chondrosarcoma, the patient died because of pulmonary metastasis. Two patients with metastatic cancer also died, and 2 cases of osteochondroma and one of benign chondroblastoma recurred. There were 47 cases of soft tissue tumour. Treatment for benign soft tissue tumours was marginal resection; no cases recurred. In contrast, all patients with soft tissue sarcoma died after surgery. The majority of bone tumours were located in the toe and hindfoot areas, in the first and second decades of life, whereas soft tissue tumours occurred mainly in the midfoot area and in patients aged between 20 and 50 years. The sex distribution was almost even for bone tumours (male: female ratio, 19: 17), whereas about half as many males as females had soft tissue tumours (14:33).

Conclusion.

Bone and soft tissue tumours of the feet are uncommon. Most bone tumours are chondrogenic, but differential diagnosis of malignant from benign disease is difficult and prognosis is poor. Management of benign tumours by marginal resection has good prognosis, whereas prognosis of soft tissue sarcomas is very poor.
Treatment of Pathological Fractures of the Humerus with a Locked Intramedullary Nail
Authors: Bauze AJ , Clayer MT
Published: October 2016

Purpose.

The humerus is a common site for metastasis. Intramedullary nail fixation has been reported to be the best form of fixation for this disease but complications occur. This study aimed to assess the use of a new humeral nail to treat pathological fractures and impending pathological fractures of the humerus.

Methods.

29 patients received 31 Austofix locked intramedullary humeral nails: 25 for pathological fractures and 6 for impending fractures; 24 nails were inserted anterograde and 7 retrograde. Cement augmentation was applied in 4 patients, and adjuvant therapy was used in 28 patients. Complications occurred in 12 patients.

Results.

Fixation failed in 6 patients: 2 due to intra-operative fractures during retrograde nailing, one due to a fracture through screw holes postoperatively, and 3 due to local progression of disease. Difficulty in distal locking of the nail was encountered in 4 patients. Locked intramedullary nailing resulted in a stable humerus in 80% of patients.

Conclusion.

Retrograde insertion of the nail is associated with an increased risk of intra-operative fracture, and disease progression can occur, despite the administration of adjuvant therapy.
Use of Epidural Analgesia for Pain Management after Major Spinal Surgery
Authors: Kumar RJ , Menon KV , Ranjith TC
Published: October 2016

Purpose.

This is a retrospective study of the role of postoperative epidural analgesia in major spinal surgical procedures. With the number and complexity of the procedures performed on the spine ever-increasing, this method of analgesia is becoming more important.

Methods.

Results of 74 consecutive cases of major spinal surgeries between January 2000 and January 2001 at the Spine Division, Amritha Institute of Medical Sciences and Research Centre, Kochi, India, were studied. 32 cases were posterior procedures and the other 42 were anterior procedures of the thoracic and lumbar regions. The use of various combinations of local anaesthetic and opioid to control postoperative pain after spinal surgery were analysed.

Results.

36 (49%) of 74 patients did not require any parenteral supplements. Of the remaining 38 patients who required supplementary parenteral analgesia in the first 48 hours, 25 (34%) received a single dose and 13 (18%) required more than one dose. The number of patients requiring parenteral analgesia immediately after operation were 11; between 2 and 6 hours were 12; and between 6 and 24 hours were 11. Of the 74 patients, 67 had a sound sleep after epidural administration. There were 2 cases of respiratory depression and 2 of transient hypotension.

Conclusion.

Most epidural analgesic regimens significantly reduced postoperative pain, and the requirement for supplementary parenteral analgesics was minimal. Adverse effects were rare, yet we recommend that patients treated with this protocol be managed in high-dependency units.
Minimally Displaced Intra-Capsular Femoral Neck Fractures in the Elderly—Comparison of Multiple Threaded Pins and Sliding Compression Screws Surgical Techniques
Authors: Wu CC , Chen WJ
Published: October 2016

Purpose.

To determine the outcome of treatment for minimally displaced femoral neck fractures using multiple threaded pins versus sliding compression screws for internal fixation.

Methods.

The medical records of 62 consecutive elderly patients with minimally displaced intra-capsular femoral neck fractures who underwent internal fixation of the fracture (37 with multiple threaded pins, and 25 with sliding compression screws) were reviewed. Clinical and radiological assessment of fracture healing at follow-up visits were noted.

Results.

In the 55 patients seen for follow-up at 3 months, 21.9% (n=7) of those treated by pinning demonstrated non-union of the fracture, and 0% of fractures treated with sliding compression screws (p=0.02). 46 patients were seen for follow-up at 1 year, with 10% (n=2) of those treated with sliding compression screws found to have osteonecrosis of the femoral head. The 2 fractures in the group treated by pinning demonstrating non-union at 3 months failed to unite by 1 year (p=0.11). 34 patients were seen for follow-up for at least 2 years, with no additional complications noted.

Conclusion.

Using sliding compression screws to treat minimally displaced femoral neck fractures can achieve a higher union rate than using pinning. The reason may be the better stability in the osteoporotic bone. However, osteonecrosis of the femoral head may occur with use of sliding compression screws because of greater intramedullary vascular damage as a result of wider reaming.
Degenerative Spondylolisthesis at the L4–L5 in a 32-Year-Old Female with Previous Fusion for Idiopathic Scoliosis: A Case Report
Authors: Winter RB , Silverman BJ
Published: October 2016

We report a case of degenerative L4–L5 spondylolisthesis in a 32-year-old female who had undergone thoracic (lower level T12) fusion as a teenager. All other levels in the lumbar spine were normal on magnetic resonance imaging. Subsequent fusion of L4–L5 led to improvement in function and alleviation of pain for more than 4 years. The possible relationship between the previous fusion and degenerative spondylolisthesis is discussed.
Medial Meniscal Cyst of the Knee—An Unusual Presentation: A Case Report
Authors: Kurian J , Schindler OS , Hussain A
Published: October 2016

We report an unusual case of a large, asymptomatic, medial meniscal cyst of the knee. Medial meniscal cysts are relatively uncommon, are usually symptomatic and in most cases are so small that only magnetic resonance imaging can confirm the diagnosis.
The Incidence of Deep Vein Thrombosis in Elderly Chinese Suffering Hip Fracture is Low without Prophylaxis: A Prospective Study Using Serial Duplex Ultrasound
Authors: Chan YK , Chiu KY , Cheng SWK , Ho P
Published: October 2016

Purpose.

To investigate the incidence of deep vein thrombosis (DVT) among elderly Hong Kong Chinese patients suffering from acute hip fracture and to analyse the risk factors associated with DVT.

Methods.

A total of 100 consecutive Chinese hip fracture patients with a mean age of 80 years were investigated serially using duplex ultrasound scans preoperatively and at 1 week, 3 to 6 weeks, and 3 months postoperatively. No chemoprophylaxis or prophylaxis against DVT was given.

Results.

95 patients completed 3 duplex scans during hospitalisation; 5 (5.3%) of them were found to have developed DVT over the ilio-femoral venous segment. Of the 90 patients who had no DVT, 73 were reassessed 3 months after operation; one of them was found to have developed calf DVT. Older patients, chair-bound or dependent patients, and patients living in institutions carried a higher risk of developing DVT.

Conclusion.

This prospective study shows that the incidence of DVT developing after acute hip fracture in Chinese geriatric patients was low. We therefore do not recommend routine chemoprophylaxis for elderly patients with hip fracture.
Cement Penetration and Stiffness of the Cement-Bone Composite in the Proximal Tibia in a Porcine Model
Authors: Bauze AJ , Costi JJ , Stavrou P , Rankin WA , Hearn TC , Krishnan J , Slavotinek JP
Published: October 2016

Purpose.

To assess the stiffness of the cement bone composite and the depth and uniformity of cement penetration into the surface of the tibial component during total knee reconstruction in a porcine model.

Methods.

The effectiveness of 3 protocols were compared: 2 commonly used cementing techniques—finger-packing of cement on the cut surface followed by impaction, and coating of the undersurface of the prosthesis with cement followed by impaction—and a new method using a tibial cement-pressurising device. Cement penetration was measured by computed tomography; stiffness was determined by hydraulic penetration testing.

Results.

Cement penetration at a depth of 1 mm was significantly greater following coating the undersurface of the prosthesis than following finger-packing (p=0.008). There was no significant difference at deeper levels or between the tibial-pressurising device group and either of the 2 other groups at any level (p>0.3 in all cases). Differences in surface stiffness by tibial plateau region were found in tibiae that had been cemented using finger-packing and in those that had had their undersurface coated, but not in tibiae that had been cemented using the tibial-pressurising device.

Conclusion.

The tibial cement-pressurising device eliminated regional differences in stiffness seen with other cementing methods. Elimination of these differences by using this device should reduce micromotion and the incidence of aseptic loosening of tibial base plates in total knee arthroplasty.
Dislocation of a Polished Femoral Stem following a Cemented Total Hip Arthroplasty: A Report of 2 Cases
Authors: Pai VS
Published: October 2016

We report 2 cases of hip dislocation after a total hip arthroplasty, which could not be successfully reduced by closed method. Post-manipulation radiographs revealed proximal migration of the prosthesis in both cases, which required open reduction. The pathogenesis and treatment of this hip dislocation is discussed.
Investigation of the Use of Drained Blood Reinfusion after Total Knee Arthroplasty: A Prospective Randomised Controlled Study
Authors: Cheng SC , Hung TSL , Tse PYT
Published: October 2016

Purpose.

To compare the use of a blood salvage and reinfusion system with standard allogeneic blood transfusion after total knee arthroplasty—a procedure associated with significant postoperative blood loss.

Methods.

Between June 2002 and May 2004, 60 patients undergoing total knee arthroplasty were randomly allocated into a reinfusion group (n=26) or a control group (n=34). Patients in the reinfusion group had their blood reinfused from drains within 6 hours of surgery. Both groups received allogeneic blood transfusions according to specified transfusion criteria if the haemoglobin level fell below 90 g/l, or in the presence of severe anaemic symptoms. Haemoglobin levels and drain output were recorded daily for 3 consecutive days after surgery.

Results.

There was no significant difference between the 2 groups in demographic data, drain output, total blood loss, and mean postoperative haemoglobin levels. Significantly more allogeneic blood was required by the control group than by the reinfusion group (p=0.022).

Conclusion.

Postoperative reinfusion of drained blood reduced the need for blood transfusion after total knee arthroplasty, while having an effect on postoperative haemoglobin level equivalent to standard allogeneic blood transfusion.
Active Mobilisation after Flexor Tendon Repair: Comparison of Results following Injuries in Zone 2 and other Zones
Authors: Hung LK , Pang KW , Yeung PLC , Cheung L , Wong JMW , Chan P
Published: October 2016

Purpose.

To prospectively study the role of active mobilisation after flexor tendon repair.

Methods.

The standard modified Kessler's technique was used to repair 46 digits in 32 patients with flexor tendon injuries. Early active mobilisation of the repaired digit was commenced on the third postoperative day. Range of movement was monitored and recovery from injury in zone 2 was compared with injury in other zones.

Results.

There were 24 and 22 injuries in zone 2 and other zones respectively. The total active motion score of the American Society for Surgery of the Hand was measured. Patients with zone-2 injuries achieved similar results to those with other-zone injuries apart from a 3-week delay in recovery. The final results were good to excellent in 71% and 77% of zone-2 and other-zone cases respectively (p<0.05). There were 2 ruptures in zone-2 and one rupture in zone-3 repairs (6.5%).

Conclusion.

Preliminary results of this study showed that active mobilisation following flexor tendon repair provides comparable clinical results and is as safe as conventional mobilisation programmes although recovery in patients with zone-2 injury was delayed.
Prevalence of Osteoarthritis, Osteoporotic Vertebral Fractures, and Spondylolisthesis among the Elderly in a Japanese Village
Authors: Horikawa K , Kasai Y , Yamakawa T , Sudo A , Uchida A
Published: October 2016

Purpose.

To study the prevalence of osteoarthritis, osteoporotic vertebral fractures, and spondylolisthesis among elderly residents of a Japanese village and to examine the correlation between radiographic evidence of abnormality and lower back pain.

Methods.

205 men (mean age, 70.7 years) and 323 women (mean age, 70.5 years) in a Japanese village participated in this cross-sectional study. Plain lateral radiographs were taken from the lower thoracic spine to the sacral spine. They were evaluated by 3 independent orthopaedic surgeons for degree of osteoarthritis (using Weiner grading system) and the presence of osteoporotic vertebral fractures and spondylolisthesis.

Results.

The prevalence of osteoarthritis in elderly Japanese villagers was 38.3%, whereas that of osteoporotic vertebral fractures and spondylolisthesis was 17.8% and 8.9%, respectively. There was no significant difference in osteoarthritis between men and women, but osteoporotic vertebral fractures and spondylolisthesis were significantly more common in females (p<0.01). No significant correlation was observed between lower back pain and radiographic evidence of degenerative spinal disease.

Conclusion.

The prevalence of spondylolisthesis in elderly Japanese was much lower than that in whites or African Americans. The prevalence of osteoarthritis or osteoporotic vertebral fractures was comparable with other English or US studies. Radiographic evidence of osteoarthritis, osteoporotic vertebral fractures, and spondylolisthesis is not necessarily associated with lower back pain.
Breakage of Intramedullary Femoral Guide Rod during Total Knee Arthroplasty: A Case Report
Authors: Chan WL , Yen CH , Wong KK , Tse PYT , Mak KH
Published: October 2016

We report a rare complication during primary total knee arthroplasty. An intramedullary femoral guide rod was broken during insertion. The broken part jammed into the isthmus of the femur. An initial attempt to push the broken rod via the proximal femur by a guide wire to the distal femur was unsuccessful because the broken rod was lodged in the isthmus. Ultimately, the isthmus was opened using a flexible 9-mm end-cutting reamer, and the broken rod was pushed down to the distal femoral entry site in an antegrade fashion under image intensification. Selecting a more medial entry site on the intercondylar notch with a smaller valgus cutting angle and using a shorter guide rod can avoid such a breakage.
One-Stage Combined Surgery with or without Preoperative Traction for Developmental Dislocation of the Hip in Older Children
Authors: Tezeren G , Tukenmez M , Bulut O , Cekin T , Percin S
Published: October 2016

Purpose.

To compare one-stage combined surgery with and without preoperative traction, in older children with developmental dislocation of the hip (DDH).

Methods.

Records of 9 children who underwent combined surgery for DDH with preoperative traction in 12 hips (group 1) and 12 undergoing the same procedure without preoperative traction in 16 hips (group 2) were retrospectively reviewed. The surgery consisted of open reduction, Salter's innominate osteotomy and femoral shortening with derotation varus osteotomy. The mean age of the patients at the time of operation was 5.8 years. The mean follow-up period was 5.9 years.

Results.

At final follow-up, clinical outcome in group 1 was worse than that in group 2, though radiographic assessment demonstrated no significant difference between the groups.

Conclusion.

One-stage combined surgery without preoperative traction is effective in the treatment of DDH in older children, and has a lower complication rate, but radiographically the groups did not differ.
Biocompatability of Hydroxyapatite Composite as a Local Drug Delivery System
Authors: Krisanapiboon A , Buranapanitkit B , Oungbho K
Published: October 2016

Purpose.

To investigate the biocompatibility of hydroxyapatite composite (hydroxyapatite, plaster of Paris, and chitosan) impregnated with gentamicin, fosfomycin, imipenem, or amphotericin B.

Methods.

The interactions of the extract from each drug against osteoblast were tested using the methylthiotetrazole test.

Results.

Extracts from all drugs showed good biocompatibility at concentrations varying from 10 μg/ml to 1000 μg/ml. Imipenem and amphotericin B at a concentration of 1000 μg/ml had a significantly higher percentage of cell viability than the control group. No morphological change of osteoblast was observed in all drug tests at any concentrations.

Conclusion.

The hydroxyapatite composite had a good biocompatibility for carrying gentamicin, fosfomycin, imipenem, or amphotericin B.
Computed Tomographic Evaluation of the Odontoid Process for Two-Screw Fixation in Type-II Fracture: A Malaysian Perspective
Authors: Yusof MI , Yusof AH , Abdullah MS , Hussin TMAR
Published: October 2016

Purposes.

To measure the diameter of the odontoid process in a Malaysian population using computed tomographic (CT) scan and determine the feasibility of treating type-II odontoid fractures using 2 cortical screws.

Methods.

CT images of the odontoid process of 85 patients aged 18 to 80 years were analysed; 69 (81%) were male (mean age, 44 years) and 16 (19%) were female (mean age, 48 years). Both anteroposterior (AP) and transverse diameters of the odontoid process were measured via axial CT images at 3 different levels: the base of the odontoid process and 1.2 mm and 2.4 mm above the base.

Results.

The mean AP and transverse diameters of the odontoid process in men were 11.3 (range, 10.0–12.6; standard deviation [SD], 0.7) mm and 10.2 (range, 8.5–12.3; SD, 0.8) mm respectively, whereas in women were 10.9 (range, 9.4–13.2; SD, 0.8) mm and 10.1 (range, 7.9–11.6; SD, 0.9) mm respectively. The difference in corresponding mean dimensions between men and women was not statistically significant. The mean AP diameter was significantly larger than the mean transverse diameter. At the base and 1.2 mm and 2.4 mm above the base, the respective transverse diameters of 4 (5%), 13 (15%), and 24 (28%) of the patients were <9.0 mm. None had an odontoid AP diameter of <9.0 mm at any level.

Conclusion.

Two 3.5-mm cortical screws appear too big for fixation in one third of our sample presenting with type-II odontoid fracture. Fixation by two 2.7-mm screws is recommended for Malaysians and other Asian populations.
Osteosynthesis for Intra-Articular Calcaneal Fractures
Authors: Jain V , Kumar R , Mandal DK
Published: October 2016

Purpose.

To correlate treatment results of intra-articular calcaneal fractures with their computed tomographic (CT) classification.

Methods.

36 men and 4 women with 48 intra-articular calcaneal fractures (8 bilateral) underwent open reduction and internal fixation with bone grafting via an extensile lateral approach. Based on 2-dimensional CT scans, the fractures were categorised using the Sanders classification. There were 16 type-II, 20 type-III, and 12 type-IV fractures. Radiographs and Maryland foot scores were used for evaluation of the results at a mean of 38 (range, 26–66) months.

Results.

Anatomic reduction of the posterior calcaneal facet was achieved in 38 of 48 fractures. The Bohler and Gissane angles were restored to between 92 and 99% of normal, respectively. Despite this, the mean functional scores were 84 in type-II, 83 in type-III and 67 in type-IV fractures.

Conclusion.

Surgical results were superior in type-II and -III fractures. Type-IV fractures fared poorly, despite excellent restoration of calcaneal anatomy; subtalar arthrodesis should have been considered.
Subcapital Femoral Neck Fracture following Successful Trochanteric Fracture Treatment with a Dynamic Hip Screw: A Report of Five Cases
Authors: Lung YT , Kam WL , Leung YF , Chung OM , Wai YL
Published: October 2016

A subcapital femoral neck fracture complicating a healed trochanteric fracture is rare. Such cases are managed in a rather heterogeneous manner, i.e. there exists a mixture of cases treated by either fixed angle devices or dynamic compression screws. We describe 5 patients who developed subcapital femoral neck fractures after healed trochanteric fractures treated with dynamic compression screws. The subjects' clinical data, operative records, and radiographs have been studied retrospectively and the literature reviewed. The risk factors for such a complication include being of advanced age, female, osteoporotic, and having a small femoral head and neck, and a basicervical type of fracture.
Occult Acetabular Fractures in Elderly Patients: A Report of Three Cases
Authors: Kakar R , Sharma H , Allcock P , Sharma P
Published: October 2016

Three elderly patients with acetabular fractures not evident on the initial plain radiographs are presented. All had a fall and were unable to bear weight. Cross-sectional imaging and repeated plain radiography confirmed fractures of the acetabulum. Occult acetabular fractures may occur in elderly patients after a fall and present with persistent discomfort and difficulty walking. When there is reason to suspect such a fracture, further diagnostic studies, including a Judet view radiograph, bone scan, computed tomographic scan or magnetic resonance image should be performed.
Resistance of Disposable Drapes to Bacterial Penetration
Authors: Blom AW , Barnett A , Ajitsaria P , Noel A , Estela CM
Published: October 2016

Purpose.

To test the bacterial penetrability of disposable non-woven drapes used specifically for total hip arthroplasty.

Methods.

12 round agar plates were inoculated with 107 colony-forming units/ml of coagulase-negative staphylococci (CNS) and incubated in air at 37°C for 18 hours to obtain a semi-confluent growth of organisms. Six brands of disposable drapes were tested; each was assigned to 2 plates. Each disposable drape was placed between a round agar plate and an inverted square agar plate filled with blood agar. After 30 and 90 minutes, the square agar plates were removed and incubated for 48 hours and inspected for growth of CNS.

Results.

Bacterial penetration was time dependant. Certain brands of drapes were more impenetrable than others; none was impenetrable at all time points, but most remained so or allowed passage of fewer than 100 colony-forming units at 90 minutes.

Conclusion.

It is recommended that drapes be rigorously tested with regard to their resistance to bacterial penetration.
Does Flexion Contracture Continue to Improve up to Five Years after Total Knee Arthroplasty?
Authors: Cheng K , Dashti H , McLeod G
Published: October 2016

Purpose.

To determine whether flexion contracture continues to improve up to 5 years after total knee arthroplasty (TKA).

Methods.

Records of 200 women and 123 men (mean age, 72 years) with osteoarthritis and preoperative flexion contracture were reviewed. 155 (48%) involved the left knee and 168 (52%) the right knee. Patients were assessed clinically before TKA and one and 5 years later, by a single researcher using a goniometer to measure flexion contracture, range of movement, maximum flexion, and the Knee Society Score. In all patients the same prosthesis design was used. The surgical technique was standard and involved a medial parapatellar approach with bone resection.

Results.

All variables improved significantly from pre-TKA to one-year post-TKA and from one-year post-TKA to 5-year post-TKA; respectively the mean flexion contracture decreased from 11° to 3° to 2°; the mean knee range of movement increased from 90° to 103° to 107°; the mean maximum flexion increased from 101° to 106° to 109°; and the mean Knee Society Scores increased from 39 to 87 to 90.

Conclusion.

Functional outcome and flexion contracture may continue to improve up to 5 years after TKA.
Anatomic Study of the Middle Genicular Artery
Authors: Salaria H , Atkinson R
Published: October 2016

Purpose.

To study the anatomy of the middle genicular artery and thus mitigate the risk of vascular injury in knee surgery.

Methods.

The course, anatomic relations, and variations of the middle genicular artery in 8 cadavers (4 men and 4 women) were studied.

Results.

The middle genicular artery originated from the anterolateral surface of the popliteal artery in the popliteal fossa, 3 to 5 cm proximal to the joint line either alone or having a common origin with the lateral genicular artery. Its diameter varied from 2 to 4 mm and it was 3 to 5 cm long. It was accompanied by 2 venae comitantes. This vascular bundle, including the middle genicular artery, ran distally, anterior to the popliteal artery, and posterior to the joint capsule, sandwiched between them. Distally it pierced the posterior joint capsule and became intra-articular. The relation of the middle genicular artery to the popliteal artery altered with the position of the knee joint. This alteration was secondary to the distal gliding of the popliteal artery with knee flexion. The middle geniculate artery formed an angle of 15° to 30° to the popliteal artery when the knee was extended, which became almost a right angle when the knee was flexed past 90°.

Conclusion.

Care must be taken when arthroscopic or open intra-articular surgery is performed in the posterior part of the knee joint using chondrotomes and saws, particularly with limited vision. Sharp dissection and diathermy under direct vision should be safer.
Primary Muscular Hydatidosis Mimicking Soft Tissue Tumour: A Report of Five Cases
Authors: Basarir K , Saglik Y , Yildiz Y , Yetis T , Cebesoy O
Published: October 2016

Primary muscular hydatidosis is rare and usually presents as an asymptomatic, slowly growing mass mimicking a soft tissue tumour. Adequate preoperative planning and wide excision is recommended, as incomplete excision may lead to anaphylactic reactions and local recurrence. It should be considered in the differential diagnosis of soft tissue tumours especially in regions endemic for the parasite.
Ossification of the Thoracic Ligamentum Flavum in an Achondroplastic Patient: A Case Report
Authors: Suzuki K , Kanamori M , Nobukiyo M
Published: October 2016

We report a case of spinal stenosis with ossification of the thoracic ligamentum flavum in a 53-year-old man with achondroplasia. Neurological signs indicated flaccid paralysis below L1, and the patient was unable to walk. Ossification of the ligamentum flavum was observed at T4/5 and T9 to T12, compressing the thecal sac. Laminectomy of T9 to L1 was performed. At one-year follow-up, the patient was able to walk with one elbow crutch.
Haemodynamic Instability Secondary to Minimally Displaced Pubic Rami Fractures: A Report of Two Cases
Authors: Chiu Y , Wong TC , Yeung SH
Published: October 2016

We report 2 patients with haemodynamic instability secondary to minimally displaced pubic rami fractures following a fall. Both complained of pain and swelling in the abdomen and groin, and had abdominal distension and bruising in the abdomen, groin, and perineum. All these may be early signs of severe vascular injury and should be treated promptly. Both patients were treated with embolisation of the injured vessels using emergency angiography.
Periarticular Calcification Causing Acute Carpal Tunnel Syndrome: A Case Report
Authors: Pai Vasu , Pai Vishal , Muir Ross
Published: October 2016

We report a case of acute carpal tunnel syndrome caused by periarticular calcification (hydroxyapatite deposition disease) around the wrist joint in a 64-year-old woman. She had acute severe pain, exacerbated by wrist movements and extension of the fingers. Her full blood count, urea, electrolytes, uric acid, calcium, phosphate, alkaline phosphatase, and thyroid function levels were all within normal ranges, and her serum was negative for rheumatoid factor. Computed tomography revealed lobulated calcification close to the volar capsule. She underwent an emergency surgical decompression of the carpal tunnel under general anaesthesia within 3 hours of presentation. The flexor tendon sheaths were excised, and ‘toothpaste-like’ chalky material (hydroxyapatite crystals) in the capsule was removed. The pain was relieved dramatically and her median nerve function recovered. She was symptom-free at the one-year follow-up.
Anterior Spinal Fusion versus Laminoplasty for Cervical Spondylotic Myelopathy: A Retrospective Review
Authors: Cheng Sze-Chung , Yen Chi-Hung , Kwok Tik Koon , Wong Wing-Cheung , Mak Kan-Hing
Published: October 2016

Purpose.

To compare outcomes of anterior spinal fusion (ASF) versus laminoplasty for cervical spondylotic myelopathy (CSM).

Methods.

Records of 26 women and 37 men aged 34 to 83 (mean, 67) years who underwent ASF or laminoplasty for CSM were reviewed. Patient demographics, duration of symptoms, pre- and postoperative Japanese Orthopaedic Association (JOA) scores, Hirabayashi recovery rate, and radiographic features (including anteroposterior canal diameter, Pavlov ratio, and number of levels compressed) were compared.

Results.

The mean duration of symptoms was 9 months. The mean follow-up period was 40 months. Patients who underwent laminoplasty were older (p=0.015) and had more levels compressed (p<0.001) than those who underwent ASF. Patients with C3/4 compression were older than those without it (p=0.044). Younger patients had higher Hirabayashi recovery rate (p=0.043).

Conclusion.

The surgical decision for ASF or laminoplasty mainly depends on the number of levels compressed and patient age. Laminoplasty is usually reserved for older patients with multiple-level involvement. Age is the main predictive factor for surgical outcome.
Incidence of Secondary Hyperparathyroidism among Postmenopausal Women with End-Stage Knee Osteoarthritis
Authors: Papavasiliou Kyriakos A , Kenanidis Eustathios I , Potoupnis Michael E , Sarris Ioannis K , Kirkos John M , Kapetanos George A
Published: October 2016

Purpose.

To evaluate the incidence of secondary hyperparathyroidism (SH) among postmenopausal women with end-stage knee osteoarthritis scheduled for total knee replacement (TKR).

Methods.

283 Caucasian postmenopausal women aged 49 to 81 (mean, 70) years with end-stage idiopathic knee osteoarthritis were scheduled to undergo primary TKR. They had been menopausal for 7 to 31 (mean, 19) years. Their preoperative serum levels of intact parathyroid hormone (I-PTH), calcium, phosphorus, creatinine, and the clearance of creatinine were evaluated.

Results.

100 patients had abnormally elevated serum I-PTH. The overall incidence of SH was 35%. Serum levels of calcium and phosphorus were elevated in 33 and 12 patients, respectively. The serum level of I-PTH correlated positively with patient age ( r=0.158, p=0.008) and serum creatinine level ( r=0.138, p=0.021) and negatively with clearance of creatinine ( r= −0.169, p=0.004).

Conclusion.

SH is common among elderly postmenopausal women and may affect bone healing and implant fixation. Preoperative screening/evaluation of the serum PTH level in postmenopausal women scheduled for TKR is recommended.
A Reciprocating Ledge Technique in Closing Wedge Osteotomy for Genu Valgum in Adolescents
Authors: Dhar Shabir Ahmed , Butt Mohammed Farooq , Mir Mohammed Ramzan , Dar Tahir Ahmed , Sultan Asif
Published: October 2016

Purpose.

To describe a technique that preserves anterior and posterior alternate ledges in a closing wedge osteotomy.

Methods.

Five patients aged 14 to 19 years underwent a closing wedge osteotomy for genu valgum in 8 limbs using a reciprocating ledge technique. A unicortical wedge of bone was removed, with the anterior and posterior cortices spared. The anterior cortex at the proximal level and the posterior cortex at the distal level were cut through. With a wobbling action, the osteotomy site was rotated, and the distal fragment externally rotated. Manual force was applied to close the osteotomy site ensuring overlapping of the reciprocal ledges. The distal fragment was translated laterally to prevent club deformity. The osteotomy site was held with one or 2 staples. Stability was tested by flexion and extension of knee.

Results.

All 8 limbs attained bone union within 12 weeks, and full range of motion within a mean of 13 (range, 12–15) weeks. The mean correction of the tibiofemoral angle was 13°. At a mean follow-up of 12 months, all patients were pain-free and none developed club deformity.

Conclusion.

Sparing reciprocal ledges in a closing wedge osteotomy for genu valgum may increase stability in the flexion-extension axis, enable early range-of-motion exercises, and facilitate early bone union.
Medical Treatment for Tumoral Calcinosis with Eight Years of Follow-up: A Report of Four Cases
Authors: Zein Ali , Alkhooly AA
Published: October 2016

Three females and one male aged 13 to 25 years and born to non-consanguineous parents presented with tumoral calcinosis. They presented with swellings on the extensor surfaces of their hips, shoulders, and/or elbows, with or without skin ulcers exuding milk-like fluid and scars from previous excisions. Their joint movements were generally free apart from mild limitation caused by skin ulceration or large masses. The masses were made up of calcified material surrounded by a dense fibrovascular reaction and occasional giant cells. Their serum uric acid, blood urea and creatinine, and creatinine clearance levels were all normal, but they had higher serum phosphorus and lower serum calcium levels. Phosphate-binding antacid was prescribed to lower the intestinal absorption of phosphorus, and their diets were adjusted to lower their phosphorus and calcium intake. After 2 years of treatment, their serum phosphorus levels dropped to, or near, normal levels. The lesions resolved completely in 2 of the patients but less so in the other 2 owing to interruption of their treatment. No recurrence, complications, or side effects were noted.
Cost Comparison of Femoral Head Banking versus Bone Substitutes
Authors: Leung Hon-Bong , Fok Margaret Woon-Man , Chow Lorraine Chi-Yan , Yen Chi-Hung
Published: October 2016

Purpose.

To compare the costs of femoral head banking versus bone substitutes.

Methods.

Records of femoral head banking from 1998 to 2008 were reviewed. The cost of allogenic cancellous bone graft was calculated by estimating the direct expenditure of femoral head procurement, screening tests, and storage, and then divided by the amount of bone harvested.

Results.

326 females and 141 males (mean age, 80.3 years) donated 470 femoral heads. Each transplantable femoral head costs US$978. Each gram of transplantable allogenic bone graft costs US$86, compared with US$9 to 26 per gram for commercially available bone substitutes.

Conclusion.

Compared with bone substitutes, femoral head banking in Hong Kong was less economical. Unless allografts yield superior outcomes, harvesting femoral heads for general usage (such as filling bone voids for fresh fractures) is not justified from a financial perspective, especially in banks dedicated to procuring bone from femoral heads only.
Wrist Arthrodesis for Brachial Plexus Palsy Using an External Fixator and a Cannulated Screw (Ioannina Technique)
Authors: Vekris Marios D , Pakos Emilios E , Soucacos Panayotis N , Gavriilidis Iosif , Beris Alexandros E
Published: October 2016

Purpose.

To present a new technique for wrist arthrodesis and review its treatment outcomes in 33 patients with brachial plexus palsy.

Methods.

26 men and 7 women (mean age, 26 years) with global brachial plexus palsy underwent wrist arthrodesis using an external fixator and a cannulated screw. All surgeries were performed under local anaesthesia by a single senior surgeon. An external fixator was applied to the radius and the metacarpal of the index finger. The articular surfaces of the radius, scaphoid, lunate, and capitate were debrided, and a cannulated screw inserted from the base of the radial styloid to the carpo-metacarpal joint of the ring finger. Cancellous allografts mixed with demineralised bone matrix were added to the decorticated wrist bones. The external fixator was removed at week 8 and the wrist protected with a short-arm splint until solid wrist fusion.

Results.

All patients achieved wrist fusion after a mean of 14 (range, 12–16) weeks. Two patients had delayed fusion and slight wrist instability, because the shorter screw was embedded in the cancellous bone and not self-tapped to the cortex. Fusion was achieved after replacement with a longer screw. No patient developed a superficial or deep wound infection; 2 developed pin track infections. All patients were satisfied with the outcome and able to perform simple daily activities after one year.

Conclusion.

Our new technique for wrist arthrodesis is less invasive. Blood loss, the risk of postoperative infection, and adhesions at the extensors are decreased.
Osteoradionecrosis of the Acetabulum in a Total Hip Arthroplasty: A Case Report
Authors: Chung Kwong-Yin , Chiu Kwok-Hing , Cheung Kin-Wing
Published: October 2016

Osteoradionecrosis is a rare complication of radiation therapy. The pelvic and facial bones are those most likely to be affected when radiotherapy is used to manage gynaecological or nasopharyngeal malignancies. We report a 78-year-old woman with osteoradionecrosis of the acetabulum in a total hip arthroplasty 4 years after radiotherapy for a carcinoma of the vagina. Osteolysis of the acetabulum with pelvic discontinuity was noted on radiographs, but the patient was asymptomatic.
Predictive Factors for Recurrence of Simple Bone Cyst of the Proximal Humerus
Authors: Teoh Kar Hao , Watts Adam C , Chee Yu-Han , Reid Robin , Porter Daniel Edward
Published: October 2016

Purpose.

To evaluate factors predictive of recurrence following curettage of simple bone cysts (SBCs) in the proximal humerus.

Methods.

Records of 29 male and 3 female patients aged 3 to 22 (mean, 11) years who underwent curettage with or without bone grafting for a solitary SBC in the proximal humerus were reviewed. The appearance, size, location, activity level, and fracture pattern of each cyst were recorded. The cyst index indicated the risk of refracture. Recurrence was defined as a refracture or enlargement of the cyst.

Results.

31 patients presented with a pathological fracture. The main symptoms were pain (n=30), loss of function (n=22), and mass/swelling (n=15). 25 patients gave a history of trauma. The duration of symptoms was less than one month. 10 patients had recurrence after a mean of 10 (range, 4–27) months; 5 were refractures and another 5 were enlargement of the cysts. Six were treated conservatively and eventually healed, whereas 4 underwent further curettage. Factors predictive of recurrence were patient age ≤5 years (p=0.014), right-sided cyst (p=0.01), larger cyst (p=0.039), multilocular cyst (p=0.004) and unimpacted fracture (p=0.04). Recurrence was not related to gender, cyst location, or cyst activity level.

Conclusion.

Most SBCs heal even if the fracture is treated expectantly. SBCs should be left alone unless symptomatic. If curettage is performed, grafts or bone substitutes should be used. More aggressive treatment might be necessary for unimpacted fractures to minimise the risk of recurrence.
Atlanto-Axial Deformity Secondary to a Neglected Odontoid Fracture: A Report of Six Cases
Authors: Ho Angela Wing-Hang , Ho Yuen-Fong
Published: October 2016

We reviewed 6 patients with atlanto-axial (C1–2) deformities secondary to neglected odontoid fractures. All patients (except one with recent injury) were asymptomatic for a long period before development of neck pain or myelopathy, despite obvious subluxation and kyphotic deformities at the C1–2 joint complex. Patients were treated conservatively, except for one who underwent posterior spinal fusion and occiput-to-C2 decompression for progressive myelopathy. The reactive new bone formation around the odontoid fracture may play a role in preventing further movement and development of myelopathy. Conservative treatment should be considered for neglected odontoid fractures in elderly patients with stable non-progressive C1–2 deformity.
Concomitant Fungal and Bacterial Atlanto-Axial Osteomyelitis: A Case Report
Authors: Yau Edmund Leung-Kai , Li Ka-Kin
Published: October 2016

Concomitant fungal and bacterial atlanto-axial osteomyelitis in immunocompetent individuals is rare. We report one such patient who underwent transoral anterior decompression and posterior occipital cervical fusion, together with antibiotic and antifungal treatment. At 16-month follow-up, the patient had made a full recovery with solid fusion. Prompt diagnosis requires a high degree of clinical suspicion, with timely use of modern imaging modalities. When the diagnosis is early, antibiotic treatment alone should suffice.
Mechanical Thromboprophylaxis for Patients Undergoing Hip Fracture Surgery
Authors: Mehta Kinjal V , Lee Haw Chou , Loh James SY
Published: October 2016

Purpose.

To evaluate the rates of deep vein thrombosis (DVT) and pulmonary embolism (PE) in hip fracture patients receiving mechanical thromboprophylaxis.

Methods.

123 men and 311 women (mean age, 76 years) admitted to our institution with hip fractures were included. 95% of patient received mechanical prophylaxis using pneumatic calf pumps intermittently for ≥20 hours per day before and after surgery. At the surgeon's discretion, 161 (37%) of them received concomitant chemical prophylaxis in the form of subcutaneous low-molecular-weight heparin (enoxaparin). Signs and symptoms of DVT and PE were monitored daily, as were calf and thigh circumference. Diagnoses were confirmed by duplex ultrasonography of the lower limbs and/or spiral computed tomography scan of the thorax.

Results.

13 patients developed symptomatic venous thromboembolism (VTE); 11 were DVT and 2 were PE. Among DVT patients, 2 had proximal and 9 had distal DVT. All these patients underwent anticoagulation and were discharged without any complications. No patients developed complications from pneumatic calf pumps (foot drop, skin abrasions or stasis). Eight patients developed bleeding tendencies during hospitalisation. No patient developed surgical wound infections. 12 patients died during hospitalisation; 8 of them from acute myocardial infarction or pneumonia, and none from PE. The median length of hospital stay was significantly longer in patients with VTE.

Conclusion.

Routine use of mechanical thromboprophylaxis is recommended in patients undergoing hip fracture surgery.
Minimally Invasive Plate Osteosynthesis for Osteofibrous Dysplasia of the Tibia: A Case Report
Authors: Nakahara Hiroyuki , Kunisada Toshiyuki , Noda Tomoyuki , Ozaki Toshifumi
Published: October 2016

Osteofibrous dysplasia occurs most frequently in the tibia and may result in deformity and pathological fracture. We report one such case in a 6-year-old girl who underwent minimally invasive plate osteosynthesis using a locking compression plate. The varus deformity of the tibia was manually corrected, and the plate was inserted without extensive surgical exposure. At 20-week follow-up, the fracture had healed completely, and she had returned to normal daily living. At 3-year follow-up, radiographs showed no progression of the varus deformity. Minimally invasive plate osteosynthesis is useful for treatment of pathological fractures caused by osteofibrous dysplasia. It preserves blood flow at the fracture site, leading to good bone healing and stability to prevent further deformity and an early return to daily activity.
Strength of the Joshi External Stabilising System
Authors: Kumar Rajeev , Gupta Anupam , Sharma VP , Mishra Sanjay
Published: October 2016

Purpose.

To conduct an in vitro strength test for the Joshi External Stabilising System (JESS) for stabilisation of tibial fractures using a cadaveric tibia and steel rods.

Methods.

The configuration of the JESS specimens was based on a 62-year-old man with a metaphyseal tibial fracture. Two types of JESS specimens were prepared, using either the tibia of an average male adult cadaver (n=1) or stainless steel cylindrical rods (n=3). The strength of the JESS rather than that of the rods was measured using a universal testing machine. The axial compressive load was gradually increased at 1 mm/min to 35 N. Axial deformation of the fracture fragment was recorded. Each experiment was repeated 3 times in identical manner. A finite element analysis of the JESS was developed. The axial compressive loads and corresponding interfragmentary displacement in the experimental specimens and in the finite element analysis were compared.

Results.

The mean strength of the JESS was 32.5 N/mm in experiments and 35.3 N/mm in finite element analysis; the difference was 8.4%. The interfragmentary displacement was directly proportional to the axial compressive load.

Conclusion.

The strength of the JESS is one fourth of that of the Ilizarov fixator, and therefore not suitable for full load bearing activities.
Calcinosis Cutis of the Hand in a Renal Failure Patient: A Case Report
Authors: Yip Siu-Leung , Koo Siu-Cheong , Yen Chi-Hung , Mak Kan-Hing
Published: October 2016

A 25-year-old woman with end-stage renal failure presented with subcutaneous calcinosis cutis that grew rapidly in both hands. Radiographs showed subcutaneous lobulated calcific deposits. Magnetic resonance imaging revealed a heterogeneous mass encasing segments of the abductor pollicis longus and extensor pollicis brevis tendons. Excision of the masses was performed. Histopathology revealed amorphous calcified deposits in fibrous tissue and a foreign body reaction. There was no evidence of a tubercular lesion. Further investigation revealed the presence of hyperphosphataemia and secondary hyperparathyroidism, despite a normal serum calcium level. Oral phosphate-lowering agents failed to control the condition, and recurrence was noted 6 months later. The patient finally underwent parathyroidectomy and has had no further recurrence.