bluuebunny/crossref_metadata_2025 huggingface dataset:
Open Reduction and Kirschner Wire Fixation with Triceps Lengthening for Neglected Elbow Dislocations
Authors: Kapukaya Ahmet , Ucar Bekir Yavuz , Gem Mehmet
Published: October 2016

Purpose.

To evaluate outcome of open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations.

Methods.

Records of 6 women and 14 men aged 7 to 60 (mean, 20) years who underwent open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations were reviewed. The dislocations were posterolateral (n=11), posterior (n=4), and posteromedial (n=5). No patient had a neurologic deficit. Elbow stiffness was the main indication for surgery. The duration of dislocation was 25 to 45 days in 11 patients and >45 days in 9; the mean was 47 days. The Mayo Elbow Performance Index (MEPI) was used to assess outcome at the final follow-up. The maximum score was 100. Scores of 90 to 100 were considered excellent, 75 to 89 good, 60 to 74 fair, and <60 poor.

Results.

The mean follow-up period was 39.1 months. At the final follow-up, the mean MEPI score was 79.3; outcome was excellent in 6 patients, good in 8, fair in 4, and poor in 2. The mean MEPI was 86.4 and 70.6 for patients with ≤45 and >45 days of dislocation, respectively. The mean range of movement improved from 20° to 84.5° (p<0.001). The 2 groups were significantly different in terms of MEPI (p=0.005) and range of movement (p=0.001). The MEPI correlated negatively with the duration of dislocation ( r= −0.562, p=0.01). The range of movement correlated negatively with patient age ( r= −0.649, p=0.002).

Conclusion.

Open reduction and Kirschner wire fixation with triceps lengthening, together with active postoperative elbow movements achieved favourable results for neglected elbow dislocations, especially in younger patients and those in whom the duration of dislocation was <45 days.
Chromium Level of Salvaged Blood in Patients Undergoing Revision Hip Arthroplasty
Authors: Maezawa Katsuhiko , Yuasa Takahito , Aritomi Kentaro , Ogawa Seiki , Maruyama Yuichiro , Nozawa Masahiko , Kaneko Kazuo
Published: October 2016

Purpose.

To evaluate the chromium level of the salvaged blood in patients undergoing revision total hip arthroplasty (THA).

Methods.

Records of 7 women and one man aged 54 to 83 (mean, 64.3) years who underwent revision THA for aseptic loosening of the acetabular component (n=6), osteolysis of the acetabulum (n=1), or migration of the outer head (n=1) were reviewed, as were 2 controls who underwent primary THA. The initial THA entailed a metal-on-metal prosthesis (n=4), a metal-on-polyethylene prosthesis (n=3), and a bipolar head prosthesis (n=1). Chromium levels in the preoperative peripheral blood and intraoperative salvaged blood were measured using atomic absorption analysis.

Results.

For controls and the patient with a bipolar head prosthesis, the mean chromium level in salvaged blood was 0.4 (range, 0.2–0.6) μg/l, which was significantly lower than that in the remaining 7 patients undergoing revision THA (mean, 5.6 μg/l; range, 1.2–9.8 μg/l).

Conclusion.

Salvaged blood of patients with a metal-on-metal prosthesis undergoing revision THA contained higher levels of chromium.
Treating Giant Cell Tumours with Curettage, Electrocautery, Burring, Phenol Irrigation, and Cementation
Authors: Moon Myung-Sang , Kim Sung-Soo , Moon Jeong-Lim , Kim Sung-Sim , Moon Hanlim
Published: October 2016

Purpose.

To report on 23 patients with giant cell tumour (GCT) of the femur or tibia treated with curettage, electrocautery, burring, phenol irrigation, and cementation.

Methods.

Records of these 14 men and 9 women aged 22 to 38 (mean, 31) years were reviewed. The most common site involved was the distal femur (n=13), followed by proximal tibia (n=8), proximal femur (n=1), and distal tibia (n=1). The lesions were classified as grade I (n=3), grade II (n=18), and grade III (n=2). Based on histology, the tumour stage was classified as grade I (n=5) and grade II (n=18). Two of these patients had recurrences, which were initially treated with simple curettage and bone grafting of the distal femur and distal tibia.

Results.

The mean follow-up period was 5.7 (range, 2.5–10.1) years. 14 of the 23 patients were followed up for over 10 years. No patient developed any local recurrence, remote metastasis, or complication related to surgery or adjuvant therapy.

Conclusion.

Combined treatment entailing curettage, electrocautery, burring, phenol irrigation, and cementation was effective in treating GCT of bone.
Legg-Calve-Perthes Disease in Two Generations of Male Family Members: A Case Report
Authors: Al-Omran Ammar K , Sadat-Ali Mir
Published: October 2016

Legg-Calve-Perthes disease (LCPD) is a type of avascular necrosis of the femoral head occurring mainly in male children and causing early osteoarthritis. We report 2 generations of 4 male family members with LCPD-like features and mutation of the COL2A1 gene of the 12q13 chromosome. If LCPD occurs in any family member, we recommend genetic analysis and counselling as well as early radiological screening of related children.
Bicompartmental versus Total Knee Arthroplasty for Medial and Patellofemoral Osteoarthritis
Authors: Tan Shi Ming , Dutton Andrew Q , Bea Kia Chuang , Kumar V Prem
Published: October 2016

Purpose.

To compare the outcome of bicompartmental knee arthroplasty (BKA) versus total knee arthroplasty (TKA) in patients with medial and patellofemoral knee osteoarthritis.

Methods.

Records of 17 women and 10 men with medial and patellofemoral osteoarthritis of the knee who underwent BKA (n=15) or TKA (n=12) were reviewed. All surgeries were performed by the same surgeon. Patient haemoglobin level, length of hospital stay, range of motion, and visual analogue score for pain were recorded, as were the Knee Society Score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the SF-36 score.

Results.

Patients treated with BKA were younger than those treated with TKA (mean age, 52 vs. 60 years; p=0.006). BKA resulted in longer mean operating time (99 vs. 85 minutes, p=0.025), less mean intra-operative blood loss (reduction in haemoglobin level) [1.2 vs. 2.4 g/dL, p=0.003), and greater mean postoperative range of movement (125° vs. 116°, p=0.019). The mean Knee Society scores, WOMAC, and SF-36 scores in both groups were not significantly different. There was no instance of implant loosening, peri-prosthetic fractures, patellar subluxation, and dislocation.

Conclusion.

Short-term outcome of BKA and TKA was comparable.
Web-Based Information on Minimally Invasive Total Knee Arthroplasty
Authors: Meena Sanjay , Palaniswamy Aravindh , Chowdhury Buddhadev
Published: October 2016

Purpose.

To evaluate information available on the internet regarding minimally invasive total knee arthroplasty (TKA).

Methods.

The 3 most popular search engines (Google, Yahoo, and MSN) were used to search the keyword ‘minimally invasive knee replacement’. The top 50 websites from each search engine were evaluated for authorship and contents; duplicate websites were not double-counted.

Results.

Of the 150 websites, 51% were authored by a hospital/university, 26% by private medical groups, 14% were news stories, and 9% were from orthopaedic industry sources. 73% offered the opportunity to make an appointment. 18% described the surgical technique, whereas only 9% explained patient eligibility. 25% described the risks, whereas only 3% made reference to peer-reviewed publications. >82% made specific claims regarding the advantages of minimally invasive surgery.

Conclusion.

Most websites providing minimally invasive TKA information were insufficient in terms of explaining surgical technique, patient eligibility, and assoicated risks.
Bipolar Hemiarthroplasty for Intracapsular Femoral Neck Fractures in Elderly Patients
Authors: Rajak Manoj Kumar , Jha Ramkinkar , Kumar Pankaj , Thakur Rajesh
Published: October 2016

Purpose.

To report outcome of 30 patients who underwent bipolar hemiarthroplasty for intracapsular femoral neck fractures.

Methods.

18 women and 12 men aged 56 to 86 (mean, 70) years with Garden type III (n=7) or IV (n=23) intracapsular femoral neck fractures underwent cemented (n=5) or uncemented (n=25) bipolar hemiarthroplasty. Pain was evaluated using the visual analogue score. Mobility status was classified as ambulation with or without aid (a cane or walker). Stability of the prosthesis was classified as stable or unstable. Functional outcome was evaluated using the Harris Hip Score.

Results.

The mean length of hospital stay was 15.3 (range, 4–29) days. At the 6-month follow-up, 21 patients had no pain, 6 had mild pain, and 3 had moderate pain. The mean Harris Hip Score was 83.1; functional outcome was excellent in 10 patients, good in 13, fair in 5, and poor in 2. The latter 2 were non-ambulatory; one of whom had sustained a periprosthetic fracture intra-operatively, which was managed by encerclage wiring, and the other had a neglected prosthetic dislocation at 3 months, which was converted to an excision arthroplasty.

Conclusion.

Bipolar hemiarthroplasty conferred good short-term outcome.
Antibiotic Prophylaxis for Hip Fracture Surgery: Three-Dose Cefuroxime versus Single-Dose Gentamicin and Amoxicillin
Authors: Jettoo Prithee , Jeavons Richard , Siddiqui Bobby , O'Brien Shaun
Published: October 2016

Purpose.

To compare a 3-dose cefuroxime regimen with a single-dose gentamicin and amoxicillin regimen as antibiotic prophylaxis for hip hemiarthroplasty in terms of microbiological outcome.

Methods.

Records of 2 matched groups of patients who underwent hip hemiarthroplasty for femoral neck fractures were reviewed. 29 men and 84 women (mean age, 82 years) who received a 3-dose cefuroxime regimen in 2006 were compared with 23 men and 84 women (mean age, 83 years) who received a single-dose gentamicin and amoxicillin regimen in 2008. Patient demographics, antibiotics prescribed in the peri- and immediate postoperative period, microbiological evidence for Clostridium difficile ‘infection’, length of hospital stay, mortality, as well as biochemical and haematological findings were reviewed.

Results.

The 3-dose cefuroxime group was significantly higher in terms of the mean length of hospital stay (17 vs. 13 days, p=0.043) and the percentage of patients receiving postoperative antibiotics (88% vs. 68%, p<0.001) and having C difficile ‘infection’ (6% vs. 0%, p=0.016). If patients with C difficile ‘infection’ were excluded, there was no significant difference in the length of hospital stay.

Conclusion.

The single-dose gentamicin and amoxicillin regimen was associated with a lower C difficile ‘infection’ rate.
Iliac Arterial Injury following Anterior Lumbar Surgery: A Case Report
Authors: Akinola Bolarinwa , Charnley Godfrey
Published: October 2016

A 31-year-old woman presented with persistent left leg pain 3 weeks after revision lumbar surgery. She had numbness of the leg immediately after surgery, followed by intense, spasmodic pain 4 days later, which was managed with analgesia. Subsequent computed tomographic angiography demonstrated occlusion of the left common iliac artery. This had been missed by her spinal surgeon and by physicians in our emergency department in 2 separate visits. Vascular complications of anterior spinal surgery can be limb- or life-threatening. A high index of suspicion is necessary.
Paget Disease of Bone in Japanese Patients: A Report of Three Cases
Authors: Nagano Satoshi , Yokouchi Masahiro , Nagayoshi Ryusaku , Sasaki Hiromi , Shimada Hirofumi , Setoguchi Takao , Ijiri Kosei , Komiya Setsuro
Published: October 2016

Paget disease of bone (PDB) is a bone metabolic disorder causing pain, fractures, and deformity. Its incidence is estimated to be 1 to 2% in Caucasians older than 55 years, but in Asian populations the incidence is rare. We report on 2 female and one male Japanese patients aged 46 to 73 years with PDB. One patient had monostotic disease with pain around the shoulder and the other 2 were asymptomatic. All patients had elevated alkaline phosphatase (ALP) levels (range, 629–957 U/L). Two patients responded to oral bisphosphonate treatment and achieved normalised ALP levels and pain relief. One patient with polyostotic disease did not show any change in ALP levels. The diagnosis of the disease and the indications for bisphosphonate treatment are discussed.
Valgus Osteotomy and Repositioning and Fixation with a Dynamic Hip Screw and a 135° Single-Angled Barrel Plate for Un-United and Neglected Femoral Neck Fractures
Authors: Gupta Sameer , Kukreja Sunil , Singh Vivek
Published: October 2016

Purpose.

To review the outcome of 60 patients who underwent valgus subtrochanteric osteotomy and its repositioning for un-united and neglected femoral neck fractures.

Methods.

60 patients (mean age, 35 years) underwent valgus subtrochanteric osteotomy and repositioning of the osteotomy and fixation with a dynamic hip screw and a 135° single-angled barrel plate for closed un-united femoral neck fractures after failed internal fixation (n=27) or neglected (>3 weeks) fractures (n=33). The most common fracture type was transcervical (n=48), followed by subcapital (n=6) and basal (n=6). All patients had displaced femoral neck fractures (Garden types 3 and 4). According to the Pauwel angle, 45 fractures were type 2 (30°–70°) and 15 were type 3 (>70°).

Results.

Patients were followed up for a mean of 3.5 (range, 2–7.5) years. The mean Pauwel angle of the fracture was corrected from 65° (range, 50°–89°) to 26° (range, 25°–28°). Bone union was achieved in 56 patients after a mean of 3.9 (range, 3–5.5) months. The mean Harris hip score improved from 65 to 87.5. Outcome was excellent in 30 patients, good in 24, and poor in 6. Four of the patients developed avascular necrosis; 2 of whom nonetheless achieved a good outcome.

Conclusion.

Valgus osteotomy and repositioning and fixation with a dynamic hip screw and a 135° single-angled barrel plate was effective treatment for un-united and neglected femoral neck fractures.
Surgical Dislocation of the Hip for Reduction of Acetabular Fracture and Evaluation of Chondral Damage
Authors: Maini Lalit , Batra Sahil , Arora Sumit , Singh Shailendra , Kumar Santosh , Gautam VK
Published: October 2016

Purpose.

To assess the outcome of open reduction and internal fixation combined with surgical dislocation of the hip for displaced acetabular fractures.

Methods.

20 men and 2 women aged 20 to 55 (mean, 28) years underwent open reduction and internal fixation combined with surgical dislocation of the hip for displaced acetabular fracture. The most common fracture pattern was bicolumnar (n=12), followed by transverse (n=6) and T-type (n=4). Femoral head chondral lesions were classified as grade 0 (no defect) to grade 4 (osteochondral defect). Fracture fragments were fixed with titanium plates and screws, and the femoral head was redislocated to inspect for intra-articular screws. The association between functional status and acetabular fracture pattern and femoral head chondral lesions was explored.

Results.

Nine patients had chondral lesions in the femoral head (mostly in the anterosuperior zone), but none in the acetabulum. All femoral heads were viable. Reduction was anatomic in 6 patients and satisfactory in 16. Functional outcome was very good in 6 patients, good in 13, medium in 2, and fair in one. No patient developed avascular necrosis of the femoral head. Four patients had iatrogenic sciatic nerve palsy. One patient developed early degenerative hip arthritis and underwent total hip arthroplasty 14 months later.

Conclusion.

Surgical dislocation of the hip facilitated anatomic reduction and inspection of any chondral lesions. It did not result in avascular necrosis of the femoral head.
Negative-Pressure Wound Therapy over Surgically Closed Wounds in Open Fractures
Authors: Suzuki Takashi , Minehara Akihiro , Matsuura Terumasa , Kawamura Tadashi , Soma Kazui
Published: October 2016

Purpose.

To evaluate the outcome of open fracture surgery with negative-pressure wound therapy (NPWT) applied directly over surgical wounds.

Methods.

Medical records of 10 men and 4 women aged 6 to 70 (mean, 43.7) years who underwent internal fixation, external fixation, or splint application for open fractures of the lower leg (n=7), foot and ankle (n=5), or knee (n=2), and NPWT were reviewed. The NPWT was applied directly over the surgical wound without a non-adherent contact layer. The foam was changed every 3 days. The standard negative pressure was 125 mm Hg. The NPWT was stopped when the wound discharge became <50 ml per day. The duration of NPWT and the level of negative pressure were recorded, as were wound condition, reasons for NPWT, and outcome.

Results.

The mean duration of NPWT was 9.1 (range, 3–24) days. Four patients developed maceration of the skin under the foam, whereas 2 patients developed skin blisters under the drape. No necrosis of flap skin or infection occurred, and all the fractures eventually united.

Conclusions.

Maceration of the skin was seen in some cases but did not affect the overall outcome. NPWT directly over the skin surface had no deleterious effect on wound and fracture healing.
First Metatarsophalangeal Joint Fusion Using a Fyxis Plate
Authors: Marudanayagam Ashok , Appan Sadai V
Published: October 2016

Purpose.

To report the outcome of fusion of the first metatarsophalangeal joint (MTPJ) using the Fyxis plate and compression screws.

Methods.

Medical records of 12 men and 39 women (54 feet) aged 28 to 74 (mean, 58) years who underwent primary fusion of the first MTPJ using the Fyxis plate and compression screws for hallux rigidus (n=38), severe hallux valgus (n=8), or rheumatoid arthritis (n=8) were reviewed. The outcome measures included the fusion rate, time to fusion, complication rate, hallux valgus angle, dorsiflexion angle, and the American Orthopaedic Foot and Ankle Society (AOFAS) scale.

Results.

The mean follow-up was 14.8 (range, 12–20) months. The mean time to fusion was 3.2 months. 48 feet achieved complete fusion at 3 months, 5 at 6 months, and one had non-union at 12 months, which was treated with revision surgery. The mean hallux valgus angle improved from 23° to 12°. The mean dorsiflexion angle improved from 22° to 23°. The mean AOFAS scale score improved from 31 to 86. 98% of the feet achieved a score of >72. One patient with non-union had a score of 59. Two feet developed superficial wound infection, which resolved with antibiotic treatment. Two other feet developed numbness over the medial aspect of the great toe, which persisted after one year.

Conclusion.

The outcome of fusion of the first MTPJ using the Fyxis plate and compression screws was good.
Patellar Clunk Syndrome in Fixed-Bearing Posterior-Stabilised versus Cruciate-Substituting Prostheses
Authors: Tang Yan Ho , Wong Wing Keung , Wong Hok Leung
Published: October 2016

Purpose.

To compare the outcome of fixed-bearing posterior-stabilised versus cruciate-substituting prostheses in 46 patients who underwent primary bilateral total knee replacement (TKR).

Methods.

Records of 35 women and 11 men aged 54 to 78 (mean, 67) years who underwent primary bilateral TKR for osteoarthritis (n=44) and rheumatoid arthritis (n=2) were retrospectively reviewed. A fixed-bearing posterior-stabilised prosthesis (Zimmer NexGen Legacy flex [LPS-Flex]) was used in one knee, and a fixed-bearing cruciate-substituting prosthesis (Depuy Press Fit Condylar Sigma CS [PFC CS]) was used in the contralateral knee. The mean time interval between the 2 operations was 34 (range, 4–60) months. All operations were performed by the same group of surgeons using standardised techniques. The medial parapatellar approach was used, and the patella was resurfaced. Rehabilitation was also standardised. Outcome measures included the pre- and post-operative active range of movement and the American Knee Society Score. Postoperative complications were documented.

Results.

At one year, the mean fixed flexion contracture, maximum flexion, and American Knee Society scores in knees with PFC CS and LPS-Flex prostheses were comparable. Three knees with the PFC CS prosthesis developed the patellar clunk syndrome, compared to none with the LPS-Flex prosthesis (p=0.24). The onset of the patellar clunk syndrome was around one year after surgery. Despite this, the axial alignment and rotation of the femoral and tibial components were good.

Conclusion.

Both prostheses produce good clinical outcome. The PFC CS prosthesis is more likely to be associated with the patellar clunk syndrome.
The Dorr Type and Cortical Thickness Index of the Proximal Femur for Predicting Peri-Operative Complications during Hemiarthroplasty
Authors: Nash William , Harris Andrew
Published: October 2016

Purpose.

To assess the Dorr proximal femoral types and the cortical thickness index for predicting peri-operative complications during hemiarthroplasty.

Methods.

Records of 53 male and 147 female elderly who underwent cemented or uncemented monopolar hemiarthroplasty for displaced intracapsular femoral neck fractures were reviewed. Any intra-operative fracture and postoperative dislocation within 30 days was recorded. The cortical thickness index was defined as the ratio of cortical width minus endosteal width to cortical width at a level of 100 mm below the tip of the lesser trochanter. Higher values indicated thicker cortices. The Dorr proximal femur morphology was classified into types A, B, and C.

Results.

28 patients were excluded. The proximal femurs of the remaining 172 patients (mean age, 85 years) were categorised as Dorr type A (n=29), type B (n=75), and type C (n=68). The respective mean cortical thickness indices were 1.10, 0.79, and 0.65. Lower cortical thickness indices correlated with worse Dorr types (p<0.05). There were 18 intra-operative fractures; 8 and 10 occurred in Dorr types B and C femurs versus none in Dorr type A femurs (p=0.046). There were 5 postoperative dislocations; 3 and 2 occurred in Dorr types B and C femurs versus none in Dorr type A femurs (p=0.591). The mean cortical thickness index was significantly lower in those with a fracture (n=18) than those without a fracture (n=154) [0.59 vs. 0.81, p=0.0003].

Conclusion.

Dorr types B and C proximal femurs were at greater risk of intra-operative fracture.
Intra-Articular Injection of Tranexamic Acid to Reduce Blood Loss after Total Knee Arthroplasty
Authors: Jang Bob , Kao Mark , Bohm Martin T , Harris Ian A , Chen Darren B , MacDessi Samuel J
Published: October 2016

Purpose.

To evaluate the effect of intra-articular tranexamic acid (TXA) on blood loss after total knee arthroplasty (TKA).

Methods.

Medical records of 73 men and 93 women (mean age, 68 years) who underwent primary TKA for osteoarthritis and received intra-articular TXA 1500 mg (n=56) or 3000 mg (n=56) or not at all (n=54) were reviewed. Reduction in haemoglobin levels on days 1 and 2 was measured, as were the rates of venous thromboembolism (VTE) and blood transfusion.

Results.

Reduction in haemoglobin levels on day 2 was significantly greater in controls (35±11 g/dl) than the 1500 mg TXA group (29±9 g/dl, p=0.005) and the 3000 mg TXA group (23±10 g/dl, p±0.001). The difference between the 2 TXA groups was also significant (p=0.002). There was a dose-dependent effect of TXA on blood loss. The rates of VTE and blood transfusion did not differ significantly between groups.

Conclusion.

Intra-articular administration of TXA is effective in reducing blood loss after TKA, without increasing the risk of VTE.
Correlation between Radiographic and Arthroscopic Findings in Asian Osteoarthritic Knees
Authors: Razak Hamid Rahmatullah Bin Abd , Heng Hwee Yee Christian , Cheng Ke Yi , Mitra Amit Kanta
Published: October 2016

Purpose.

To evaluate the correlation between radiographic and arthroscopic findings for severity of knee osteoarthritis (OA) in 119 Asians.

Methods.

Medical records of 52 men and 67 women aged 33 to 70 (mean, 51) years who had complaints of chronic mechanical knee pain for >3 months and were arthroscopically diagnosed with articular cartilage degeneration of the knee were reviewed. The severity of knee OA was classified using the Kellgren-Lawrence (K&L) scale and the modified Outerbridge classification. The highest grade in any compartment of the knee was used to represent the severity of OA. The correlation between the radiographic and arthroscopic findings for severity of knee OA was evaluated.

Results.

17 of the 119 patients with no radiographic evidence of OA (K&L grade 0) had articular cartilage degeneration arthroscopically (mean grade, 1.14). In general, higher K&L grades correlated with more severe articular cartilage degeneration. The Pearson correlation coefficient was 0.32, indicating that the association between the radiographic and arthroscopic findings for severity of knee OA was weak.

Conclusion.

The K&L scale correlated poorly with arthroscopic findings of articular cartilage degeneration in an Asian population with knee OA.
Measured Resection versus Gap Balancing Technique for Femoral Rotational Alignment: A Prospective Study
Authors: Nikolaides Anastasios P , Kenanidis Eustathios l , Papavasiliou Kyriakos A , Sayegh Fares E , Tsitouridis Loannis , Kapetanos George A
Published: October 2016

Purpose.

To compare the measured resection technique and the gap balancing technique for correction of the femoral rotational alignment.

Methods.

57 women and 6 men (mean age, 70 years) with end-stage osteoarthritis and ±15° malalignment and ±10° flexion contracture of the knee underwent primary total knee arthroplasty through the medial approach using the measured resection technique (n=34) or the gap balancing technique (n=29). Femoral rotational alignment was evaluated before and 7 days after surgery using computed tomography by referencing the 2 posterior condyles to the transepicondylar axis.

Results.

The 2 groups did not differ significantly in terms of correction of the femoral rotational alignment (3.4°±1.4° vs. 3.5°±3.1°, p=0.817).

Conclusion.

The measured resection and the gap balancing techniques achieved comparable correction of femoral rotational alignment.
Fixation with Cancellous Screws and Fibular Strut Grafts for Neglected Femoral Neck Fractures
Authors: Pal Chandra Prakash , Kumar Binod , Dinkar Karuna Shankar , Singh Pulkesh , Kumar Harish , Goyal RK
Published: October 2016

Purpose.

To review the outcomes of fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures.

Methods.

44 men and 28 women aged 17 to 50 years with neglected femoral neck fractures of the subcapital (n=12), transcervical (n=57), or basal (n=3) types underwent closed (n=39) or open (n=33) reduction and fixation with a single cancellous screw with double fibular strut grafts (n=24) or fixation with double cancellous screws with a single fibular strut graft (n=48). The mean time from injury to surgery was 10 weeks; the delay was 22 to 35 days in 43 patients and >35 days in 29 patients. Double fibular strut grafts were used for 18 patients with longer delay and resorption of the femoral neck, and 18 patients with posterior comminution of the femoral neck. The outcome was assessed using the Harris hip score.

Results.

Patients were followed up for a mean of 3 years. The time to bone union was 3 to 4 months in 48 patients, 4 to 5 months in 15, and 5 to 6 months in 5; nonunion was noted in 4 patients. In 18 patients with resorption of the femoral neck, bone union took a longer time. The Harris hip score was excellent (90–100) in 30 patients, good (80–89) in 20, fair (70–79) in 15, and poor (±70) in 7. Of the latter, 4 had nonunion and 3 developed avascular necrosis of the femoral head; they had persistent pain and restriction of hip joint movement.

Conclusion.

Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures is cost-effective and technically less demanding, and associated with good outcomes.
Locking Plate Fixation with and without Inferomedial Screws for Proximal Humeral Fractures: A Biomechanical Study
Authors: Burke Neil G , Kennedy Jim , Cousins Grainne , Fitzpatrick David , Mullett Hannan
Published: October 2016

Purpose.

To compare the efficacy of locking plate fixation with and without inferomedial screws in maintaining the reduction of a proximal humeral fracture.

Methods.

22 synthetic humerus models were used. A standardised 3-part proximal humeral fracture with a 4-mm wedge segment was created and fixed with a locking plate and screws with (n=11) and without (n=11) inferomedial screws. The intrafragmentary motion of the construct at 250, 500, 750, and 1000 cycles of 532 N loading, and the load to failure of the 2 groups were compared.

Results.

Locking plate fixation with inferomedial screws reduced the mean intrafragmentary motion in all cycles (p±0.01) and increased the load to failure (1452 N vs. 1159 N, p±0.001), compared to fixation without inferomedial screws.

Conclusion.

Additional inferomedial screws provide medial column support for fracture healing. This may reduce intrafragmentary motion and thus implant complications resulting from varus malalignment such as screw perforation or loss of reduction.
Modified Boytchev Procedure for Recurrent Anterior Dislocation of Shoulder
Authors: Chandra Rajesh , Sharma VK , Mahajan Sumit , Bansal Manish , Arora Sumit
Published: October 2016

Purpose.

To evaluate results of the modified Boytchev procedure for recurrent anterior dislocation of the shoulder in 60 patients.

Methods.

Medical records of 45 men and 15 women aged 20 to 44 years who underwent the modified Boytchev procedure for recurrent anterior dislocation of the right (n=44) and left (n=16) shoulders were reviewed. The mean number of dislocations was 14. Outcome was evaluated using the Burkhead and Rockwood criteria.

Results.

The mean follow-up period was 56 months. Outcome was excellent in 32 patients, good in 21, and fair in 7. None had poor outcome. The mean external rotation deficit at 0° and 90° of abduction improved from 14° to 7° (p=0.04) and 18° to 7° (p=0.03), respectively. Two patients had fragmentation of the coracoid process, which was fixed with non-absorbable suture. Two patients had traction injury to the musculocutaneous nerve, which recovered after 6 months. One patient had recurrent dislocation that ruled out the chance of revision surgery.

Conclusion.

The modified Boytchev procedure is a viable and simple treatment for recurrent anterior shoulder dislocation.
Associations between Isolated Bundle Tear of Anterior Cruciate Ligament, Time from Injury to Surgery, and Clinical Tests
Authors: Fok August Wai-Ming , Yau WP
Published: October 2016

Purpose.

To evaluate the associations between isolated anteromedial (AM) or posterolateral (PL) bundle tear of the anterior cruciate ligament (ACL), the time from injury to surgery, and various clinical tests.

Methods.

36 women and 189 men aged 16 to 52 (mean, 26.4) years underwent ACL reconstruction of the right (n=107) and left (n=118) knees. Patients were evaluated for the International Knee Documentation Committee Subjective Knee Score, Cincinnati Knee Rating System Score, anterior drawer test, Lachman test, pivot shift test, KT1000 arthrometer measurement, isokinetic muscle tests of the extensors, and functional tests (single leg hop and timed hop test). Examination under anaesthesia (EUA) was also performed, followed by diagnostic arthroscopy. The integrity of the ACL bundles was tested using a probe. The AM and PL bundles were morphologically intact if structurally present, and functionally intact if not lax on probing.

Results.

Of the 225 patients, 8 had isolated AM bundle tears, 2 had isolated PL bundle tears, and 215 had complete ACL tears in terms of function. The corresponding numbers were 30, 13, and 182 in terms of morphology. Compared with patients with complete ACL tear, the mean time from injury to surgery was significantly shorter in patients with isolated AM or PL bundle tear in terms of function (17.5 vs. 5.6 months, p±0.001) and morphology (17.5 vs. 8.8 months, p±;0.001). Compared with patients with complete ACL tear, those with a functionally intact PL bundle had a higher rate of negative pivot shift test in preoperative evaluation (1% vs. 17%, p=0.002) and EUA (1% vs. 63%, p±0.001), and had a higher rate of negative Lachman test in EUA (1% vs. 25%, p=0.02).

Conclusion.

The time from injury to surgery was shorter in patients with isolated bundle ACL tear. In patients with ACL deficiency, the pivot shift test was useful in detecting an intact PL bundle.
Diagnostic Value of Magnetic Resonance Imaging in Thoracic Outlet Syndrome
Authors: Singh Vinay Kumar , Jeyaseelan Luckshmana , Kyriacou Steve , Ghosh Subhojit , Sinisi Marco , Fox Michael
Published: October 2016

Purpose.

To evaluate the diagnostic value of magnetic resonance imaging (MRI) in thoracic outlet syndrome (TOS).

Methods.

Medical records of 30 women and 10 men aged 18 to 68 (mean, 38) years who presented with unilateral (n=35) and bilateral (n=5) TOS and underwent 42 surgical decompressions of the right (n=23) and left (n=19) sides were reviewed. MRI findings were compared with intra-operative findings to evaluate the diagnostic value of MRI.

Results.

MRI findings correlated poorly with intraoperative findings. Of the 42 cases, MRI and intraoperative findings were matched in 17 and not matched in 25. MRI appeared normal but intraoperative findings were in fact positive for TOS in 23 of 24 cases. The sensitivity and specificity of MRI in diagnosing TOS were 41% and 33%, respectively, whereas its positive and negative predictive values were 89% and 4%, respectively.

Conclusion.

Sensitivity and specificity of MRI in diagnosing TOS are low. Diagnosis should be based on a holistic approach including history, clinical examination, and radiological findings.
Asymptomatic Cement Embolism in the Right Atrium after Vertebroplasty Using High-Viscosity Cement: A Case Report
Authors: Pannirselvam Vinodhkumar , Hee Hwan Tak
Published: October 2016

A 52-year-old woman underwent vertebroplasty for fractures of the T10, T11, and L2 vertebrae secondary to multiple myeloma. She was discharged uneventfully within a week. Nine months later, she was readmitted for syncope. Echocardiography revealed a mass in the right atrium. Magnetic resonance imaging (MRI) revealed a low signal intensity irregular mass (8×7 mm) and a comma-shaped mass (12 mm) in the right atrium. She was prophylactically anticoagulated for the probable emboli. Repeat cardiac MRI performed 2 weeks later showed that the size of the masses remained unchanged. Surgical intervention was not suggested by the cardiothoracic surgeons. Three months later, the patient remained uneventful.
Pelvic Haemophilic Pseudotumour: A Case Report
Authors: Kamal Achmad Fauzi , Sukrisman Lugyanti , Dilogo Ismail Hadisoebroto , Priyamurti Heka , Qomaruzzaman Muhammad Nurul
Published: October 2016

We report on a 30-year-old haemophilic man with a pelvic pseudotumour compressing adjacent structures causing pain and swelling and destruction of surrounding soft tissues and bones. He underwent evacuation of the pseudotumour, acetabular reconstruction using the Harrington procedure, and total hip arthroplasty.
Proximal Femoral Locking Compression Plate for Proximal Femoral Fractures
Authors: Lee Wei Ting , Murphy Diarmuid , Kagda Fareed HY , Thambiah Joseph
Published: October 2016

Purpose.

To review short-term outcomes of proximal femoral locking compression plate (PF-LCP) fixation for proximal femoral fractures in terms of postoperative complications and failure rates.

Methods.

Medical records of 21 men and 5 women aged 22 to 85 (mean, 49.7) years who underwent internal fixation with the PF-LCP for proximal femoral fractures were reviewed. Younger patients (mean age, 38.7 years) were more commonly involved in high-energy trauma with multiple musculoskeletal injuries, whereas older patients (mean age, 67.7 years) were more commonly involved in low-energy trauma. Fractures were classified into: multi-fragmentary pertrochanteric fractures (n=13), transtrochanteric fractures (n=6), and subtrochanteric/proximal diaphyseal fractures (n=7).

Results.

Patients were followed up for a mean of 14.7 months. Seven patients developed complications including loosening of locking screws (n=4), delayed union (n=2), and infection (n=1); 4 of them required additional surgeries.

Conclusion.

The PF-LCP is appropriate for complex proximal femoral fractures with poor bone quality, revision surgeries, and multi-fragmentary subtrochanteric/proximal diaphyseal fractures. For intertrochanteric fractures, the sliding hip screw system should be used to avoid failure.
Early versus Late Flap Coverage for Open Tibial Fractures
Authors: Chua Weiliang , De Soumen Das , Lin Wong Keng , Kagda Fareed , Murphy Diarmuid
Published: October 2016

Purpose.

To compare early versus late flap coverage for open tibial fractures.

Methods.

Medical records of 83 men and 6 women (mean age, 38 years) who underwent fixation for open tibial fractures (Gustilo grades IIIB and IIIC) followed by flap coverage within (n=30) or after (n=59) 72 hours were reviewed. All fractures were treated within 24 hours. Outcome measures included bone union, infection, flap failure, the need for secondary procedures to achieve union, and eventual amputation. The early and late flap coverage groups were compared.

Results.

Early flap coverage was associated with shorter length of hospitalisation (31.4 vs. 55.8 days, p<0.01), lower deep infection rates (23% vs. 54%, p<0.01), and smaller number of surgical procedures (6.4 vs. 9.2, p=0.01). The 2 groups did not differ significantly in terms of the time to bone union, flap failure, amputation, and the need of secondary procedures to facilitate bone union.

Conclusion.

In severe open tibial fractures, early soft-tissue coverage (within 72 hours) was associated with more favourable outcomes in terms of length of hospitalisation and infection.
Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures
Authors: Devkota Pramod , Khan Javed A , Shrestha Suman K , Acharya Balakrishnan M , Pradhan Nabeesman S , Mainali Laxmi P , Khadka Padam B , Manandhar Hemanta K
Published: October 2016

Purpose.

To review the outcomes of 53 patients who underwent minimally invasive plate osteosynthesis (MIPO) for distal tibial fractures.

Methods.

Medical records of 31 men and 22 women aged 22 to 78 (mean, 51) years who underwent MIPO using a locking compression plate for distal tibial fractures of the left (n=28) and right (n=25) legs with or without intra-articular extension were reviewed.

Results.

Patients were followed up for a mean of 26 (range, 24–38) months. The mean time from injury to surgery was 9 (range, 3–12) days. The mean operating time was 105 (range, 75–180) minutes. The mean hospital stay was 16 (range, 8–25) days. Non-weight bearing walking with a crutch was started after a mean of 5.7 (range, 3–9) days. The mean time to callus formation was 12 (range, 8–15) weeks. The mean time to full weight bearing was 15 (range, 8–22) weeks. The mean time to bone union was 25 (range, 20–30) weeks. All except 2 fractures united anatomically. At 10 months, the range of motion of the ankle joint in all patients was similar to the contralateral side. Two patients had malunion but this was not clinically significant. Five patients had superficial infection, and 2 patients had persistent pain.

Conclusion.

MIPO is effective for closed, unstable fractures of the distal tibia. It reduces surgical trauma and preserves fracture haematoma.
Clavicular Hook Plate for Grade-III Acromioclavicular Dislocation
Authors: Steinbacher Gilbert , Sallent Andrea , Seijas Roberto , Boffa Juan Manuel , Espinosa Wenceslao , Cugat Ramón
Published: October 2016

Purpose.

To review the outcomes of clavicular hook plate fixation for grade-III acromioclavicular (AC) dislocation in young athletes.

Methods.

Medical records of 14 male and 5 female athletes aged 18 to 49 (mean, 29) years who underwent fixation with a 3.5-mm-thick, 15-mm-long clavicular hook plate for acute grade-III AC dislocation were reviewed. The visual analogue score for pain and the Constant shoulder score were assessed.

Results.

The mean follow-up was 4.2 years. The mean visual analogue score for pain was 1.8 (range, 1–3). The Constant shoulder score was excellent (≥90) in 14 patients and good (83–89) in 5 patients. All patients achieved range of motion equal to that of the contralateral side at week 5. Sports activities were resumed by month 6 at the latest.

Conclusion.

The clavicular hook plate for grade-III AC dislocation enables quick return to sports activities and achieves good-to-excellent functional outcome.
Fixation Strength at the Interface between Kerboull-Type Plate and Bone Cement
Authors: Kaku Nobuhiro , Hara Katsutoshi , Tabata Tomonori , Tsumura Hiroshi
Published: October 2016

Purpose.

To evaluate the fixation strength at the interface between the Kerboull-type plate and bone cement in 6 experimental conditions.

Methods.

Experimental materials comprised a simulated acetabular block, a simulated Kerboull-type plate, a pressuriser cover, a pressuriser arm, and bone cement. The simulated Kerboull-type plate was placed on the simulated acetabular block, with the pressuriser cover. Bone cement was added and the pressuriser arm was inserted. After 6 days of curing, pulling tests were performed to measure the fixation strength at the interface between the plate and the bone cement. Six experimental conditions were evaluated. In condition 1, a 1-mm plate was used with no gap between the plate and the acetabular block. In condition 2, a 2.5-mm plate was used with no gap. In condition 3, a 2.5-mm plate was used with a 2-mm gap. In condition 4, the plate was not used. In condition 5, condition 2 was tested with the model rotated 45°. In condition 6, condition 3 was tested with the model rotated 45°.

Results.

The maximum fixation strengths in conditions 1, 2, 3, 5, and 6 were 44.4 N, 59.1 N, 122.5 N, 86.9 N, and 185.2 N, respectively. The most important factor affecting the maximum fixation strength was bone cement at the interface between the plate and the acetabular block, followed by 45° rotation during testing, and then thickness of the plate.

Conclusion.

To enhance fixation of the Kerboull-type plate with cemented acetabular cup, penetration of cement into the outer side of the Kerboull-type plate should be minimised.
Reconstruction of the Distal Radius with Non-Vascularised Fibular Graft after Resection of Giant Cell Tumour of Bone
Authors: Humail Syed Mujahid , Ghulam Mustaff KK , Zaidi Itaat Hussain
Published: October 2016

Purpose.

To evaluate outcomes of wide resection and reconstruction of the distal radius with non-vascularised autogenous fibular grafts for giant cell tumour (GCT) of bone.

Methods.

Medical records of 7 men and 5 women aged 22 to 47 (mean, 31) years who underwent wide resection of the distal radius and reconstruction with non-vascularised autogenous fibular grafts for GCT of bone were reviewed. The mean length of the resected radius was 9 (range, 7–11) cm. The ipsilateral proximal fibula with a small portion of attached ligament was harvested. The articular surface of the graft was fixed to the scapholunate articular surface by Kirschner wires, and the ligament of the fibular head was sutured to the carpal ligaments. The graft was fixed to the proximal radius with a small dynamic compression plate. Iliac cancellous bone graft was added. Pain, instability, and functional status were assessed. Wrist joint movements were measured using a goniometer. The grip strength was measured. The operated and contralateral sides were compared.

Results.

The mean follow-up was 24 (range, 20–27) months. All patients achieved radiological union after a mean of 16 (range, 14–20) weeks. The mean active range of movement in the operated wrists was 32° dorsiflexion, 38° palmar flexion, 15° radial deviations, 12° ulnar deviations, 50° supination, and 60° pronation. Compared with the contralateral wrists, the operated wrists regained 60% of the function, with satisfactory grip strength, and normal finger and thumb movements and hand sensation. No patient had recurrence after 2 years. Two patients had minor dorsal subluxation, which was resolved with a wrist brace. Three patients had superficial infection, which was resolved with intravenous antibiotics and dressings. Two patients had peroneal nerve palsy, which recovered completely in 12 weeks.

Conclusion.

Non-vascularised fibular grafts for reconstruction of the distal radius after resection of a GCT of bone achieved good cosmetic and functional outcomes.
Radiographic Changes in Nutritional Ricket Hips in Children in Response to Treatment
Authors: Agarwal Anil , Talwar Jatin
Published: October 2016

Purpose.

To review radiographic changes in the proximal femurs of children of different ages during the course of treatment for nutritional rickets.

Methods.

Pelvic radiographs of 161 children aged ≤13 years with nutritional rickets were retrospectively reviewed. Patients were treated with dietary counselling and vitamin D and calcium supplementation. Patients were followed up at week 3 and thereafter at a 2-month interval until ulnar convexity was achieved. Sequential radiographs of the hips in children of different ages were reviewed for each growth plate in terms of (1) the direction of growth, (2) active areas, (3) contribution of growth, and (4) the structure of the epiphysis. Radiographs were superimposed for comparison by matching the triradiate cartilage and the ischial portion of the obturator foramen.

Results.

The direction of growth of the growth plates was from the physeal plate that is the longitudinal growth plate of the neck (LGP), the femoral neck isthmus (FNI), and the trochanteric growth plate (TGP) to the diaphyseal region, and from the perichondrium to the ossification centre in the proximal femoral epiphysis. Before the age of one year, the growth zone of the proximal femur was homogenous, with no differentiation between the LGP, FNI, and TGP. By the age of 2 years, the differentiation was more clearly established; the FNI was usually smaller than the TGP and LGP. By the age of 3 years, the FNI became prominent and the TGP remained small. By the age of 4 years, the ossification centre of the greater trochanter appeared, and the LGP extended medially as a medial overhang (MOH). During the children's growth, the LGP, FNI, or TGP remained active to a variable extent and were distinct until the age of 6 years. Gradually, the periphery of the LGP became less active than the centre of the LGP and gave rise to the ‘eye sign’. The MOH generally ceased to be active beyond the age 9 years. By the age of 12 years, the TGP and FNI were minimally active and only the centre of the LGP remained active.

Conclusion.

The mineralisation process of healing rickets provides a useful biological marker for patterns of growth. Knowledge of the quantitative contribution of various growth plates of the proximal femur in childhood may increase the understanding of the pathomechanism of hip deformations.