bluuebunny/crossref_metadata_2025 huggingface dataset:
Review Article: Total Wrist Arthroplasty
Authors: Nair Rajesh
Published: October 2016

18 English-language studies published between January 2003 and April 2013 were retrieved from the MEDLINE database using the key word ‘total wrist arthroplasty’. In most studies, total wrist arthroplasty achieved improvement in pain and function over time. In a meta-analysis, the revision rate was 17% for third-generation implants. The survival rate was 92% for fourth-generation implants at 4 years. Complication rates ranged from 0% to 100% for third-generation implants and from 6% to 47% for fourth-generation implants. Results of total wrist arthroplasty vary greatly; longer-term studies are needed to determine its cost-effectiveness.
Platelet-Rich Plasma versus Corticosteroid Injection for Recalcitrant Lateral Epicondylitis: Clinical and Ultrasonographic Evaluation
Authors: Gautam VK , Verma Saurabh , Batra Sahil , Bhatnagar Nidhi , Arora Sumit
Published: October 2016

Purpose.

To evaluate the clinical and ultrasonographic changes in the morphology and vascularity of the common extensor tendon after injecting platelet-rich plasma (PRP) or corticosteroid (CS) for recalcitrant lateral epicondylitis (LE).

Methods.

30 patients aged 18 to 60 years with recalcitrant (>6 months) LE not responsive to oral medication or non-invasive treatment were randomised to receive PRP (n=15) or CS (n=15) injection. Patients were assessed using the visual analogue scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand Scale (DASH) score, Oxford Elbow Score, modified Mayo Clinic performance index for the elbow (modified Mayo score), and hand grip strength. Ultrasonography was performed by a musculoskeletal ultrasonologist to evaluate for tear at the common extensor origin, oedema at the common extensor origin, cortical erosion, probe-induced tenderness, and thickness of the tendon.

Results.

The VAS for pain, DASH score, Oxford Elbow Score, modified Mayo score, and hand grip strength all improved significantly from pre-injection to the 6-month follow-up in the PRP and CS groups. However, in the CS group, the scores generally peaked at 3 months and then deteriorated slightly at 6 months indicating recurrence of symptoms, which involved 46.7% of the CS patients. At 6 months, the number of patients positive for various ulrasonographic findings generally decreased. However, in the CS group, the number of patients with reduced thickness of the common extensor tendon increased from 2 to 12, and the number of patients with cortical erosion at the lateral epicondyle increased from 9 to 11.

Conclusion.

PRP appeared to enable biological healing of the lesion, whereas CS appeared to provide short-term, symptomatic relief but resulted in tendon degeneration.
Cannulated versus Non-Cannulated Cancellous Screw Fixation for Femoral Neck Fractures: A Synthetic Bone Biomechanical Study
Authors: Gardner AW , Toh MZ , Yew KSA , Lie DTT , Chou SM
Published: October 2016

Purpose.

To compare the compressive strength of cannulated versus non-cannulated cancellous screws for undisplaced femoral neck fractures in synthetic bones.

Methods.

18 synthetic proximal femurs simulating an AO B1 valgus impacted femoral neck fracture in osteoporotic bone were used. The fracture angles were between 55° and 63° (Pauwels grade 2). Fixation was made using 6.5-mm non-cannulated screws (n=6), 6.5-mm cannulated screws (n=6), or 7.3-mm cannulated screws (n=6). A custom-built jig was designed to guide the insertion of the screws in an identical triangular configuration. Screws were tightened by a single operator using a torque-measuring screwdriver. The femoral head was subjected to progressive axial loading at 5 mm/min. The load to failure and displacement were recorded.

Results.

The 3 groups did not differ significantly except that the load to failure was higher in the construct with 6.5-mm non-cannulated screws than that with 6.5-mm cannulated screws (1222 N vs 1008 N, p=0.003).

Conclusion.

The compressive strength of a synthetic bone hip fracture model fixed with non-cannulated screws was higher than that of cannulated screws of the same diameter.
Effect of Soft-Tissue Attachment on Tibial Fracture Healing in Rats
Authors: Reikeras Olav , Winge Mona I , Røkkum Magne
Published: October 2016

Purpose.

To compare tibial fracture healing in rats with or without soft-tissue attachment.

Methods.

The left tibias of 30 Wistar rats were osteotomised and equally randomised into 3 groups. In the avascular segmental fracture group, an 8-mm bone segment were first removed and then immediately put back. In the vascular segmental fracture group, the 8-mm bone segment was not displaced, with periosteal and muscular attachments. In the simple fracture group, a simple fracture in the middle tibia was made. All tibias were then stabilised with an intramedullary nail through the patellar tendon, and the wound was closed with sutures. After 8 weeks, all left tibias and 9 of the intact right tibias were harvested. Bone mineral content and density of the calluses were assessed using dual energy X-ray absorptiometry scanning. The maximum torsional strength, rigidity, and energy to failure of the tibias were measured.

Results.

All tibias healed (callus formation), without mal-union or pin migration. The 3 groups did not differ significantly in terms of torsional strength, rigidity, energy to failure, bone mineral content, and bone mineral density. The mean torsional strength of the 9 intact tibias was significantly higher than the healed tibias (14.9 vs. 10.6 Nmm, p=0.021).

Conclusion.

Soft-tissue detachment from bone segments did not impair bone healing in rats.
Ankle Lateral Ligament Reconstruction for Chronic Instability
Authors: Yong Ren , Lai Kah Weng , Ooi Lai Hock
Published: October 2016

Purpose.

To report the outcome of a technique combining direct anatomic reconstruction of the anterior talofibular ligament (ATFL) with augmented reconstruction using the peroneus brevis tendon fixed by a bio-absorbable interference screw.

Methods.

13 men and 2 women aged 17 to 36 (mean, 24) years with recurrent inversion injuries of the right (n=5) and left (n=10) ankles underwent lateral ankle reconstruction by a single surgeon. All patients had a positive anterior drawer test and heel eversion stress test, and some degree of tenderness to palpation over the anterolateral joint capsule. All patients had complete or partial tear of the ATFL and the calcaneofibular ligament, except for one. The torn ligaments were repaired anatomically and reinforced with a split peroneus brevis tendon rerouted through the fibula and fixed with a bioabsorbable interference screw. The outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and the Foot and Ankle Outcome Score (FAOS) at 6 months.

Results.

The mean time from injury to surgery was 40.5 months. The mean follow-up duration was 13.6 (range, 6–26) months. No patient had surgical or wound complications. The mean AOFAS ankle and hindfoot score was 91.5 (median, 93; range, 79–100). The mean FAOS was 78.8 (median, 77; range, 61– 100). 10 patients had no limitation in both daily and recreational activities; 3 had limitation in recreational activities, and 2 had limitation in both. 12 patients had normal and 3 had moderate limitation in hindfoot motion. One patient had hindfoot instability.

Conclusion.

The combination of augmented and direct anatomic reconstructions enables early mobilisation despite limitation in hindfoot motion and is a viable option for chronic hindfoot instability.
Short-Term Outcome after Computer-Assisted versus Conventional Total Knee Arthroplasty: A Randomised Controlled Trial
Authors: Lee Wei Ting , Chin Pak Lin , Lo Ngai Nung , Yeo Seng Jin
Published: October 2016

Purpose.

To compare the short-term functional outcome after computer-assisted total knee arthroplasty (TKA) versus conventional TKA.

Methods.

23 men and 67 women aged 48 to 80 years were randomised to undergo (1) conventional TKA using an intramedullary guide, (2) conventional TKA using an extramedullary guide, or (3) computer-assisted TKA. Two senior surgeons performed all the TKAs using the same TKA system and the standard anteromedial arthrotomy with eversion of the patella. Patients were assessed by physiotherapists before and 6 months and 2 years after TKA using the Short Form-36 Health Survey, Oxford Knee Score, and Knee Society Score.

Results.

Of the 90 patients, 67 and 70 were assessed at 6 months and 2 years after TKA, respectively. No patient developed deep infection or required revision surgery. Functional outcomes of the 3 groups did not differ significantly at the corresponding follow-ups.

Conclusion.

Significant improvement in the functional outcome was not shown in patients treated with computer-assisted TKA, compared with conventional TKA. Thus, computer-assisted TKA has limited additional short-term benefits. Further studies with longer follow-up are required to examine the benefits of computer-assisted TKA.
Arthroscopic Debridement for Bilateral Calcific Tendinitis of the Subscapularis Tendons: A Case Report
Authors: Tung Kam-Lung , Woo Siu-Bon
Published: October 2016

We report on a 36-year-old man who underwent arthroscopic debridement for bilateral calcific tendinitis of the subscapularis tendons. The patient had a positive coracoid impingement test for both shoulders. Radiology showed calcific deposits at the insertion of both subscapularis tendons, close to the lesser tuberosities and just posterior to the coracoid tips. The patient underwent sequential arthroscopic coracoplasty and removal of calcific deposits in the subscapularis tendons. The patient returned to work 6 weeks after each surgery. At 2 years, the patient had no shoulder pain, with full range of motion and full power of the subscapularis muscles. The coracoid impingement test was negative for both shoulders. There was no evidence of recurrence.
Inferior Dislocation of the Hip: A Case Report and Literature Review
Authors: Jain Sameer , Haughton Benjamin A , Grogan Richard J
Published: October 2016

We report on a 17-year-old man who underwent open reduction and internal fixation for an inferior dislocation of the right hip and displaced fractures of the right femoral head and neck, and antegrade intramedullary nailing for a displaced fracture of the left femoral shaft. In addition, 13 men and 4 women aged 5 to 56 (mean, 23) years with 16 unilateral and one bilateral inferior dislocation of the hip were reviewed from the literature.
Gender-Specific Total Knee Arthroplasty in Singaporean Women
Authors: Lim Jason Beng Teck , Chong Hwei Chi , Ling Kevin , Teo Amanda , Yeo Seng Jin , Chia Shi-Lu , Chin Pak Lin , Tay Darren , Lo Ngai Nung
Published: October 2016

Purpose.

To compare the outcome of 145 women who underwent conventional total knee arthroplasty (TKA) with 77 women who underwent gender-specific TKA.

Methods.

Records of 222 women who underwent primary TKA using a conventional (n=145) or gender-specific (n=77) size E or F prosthesis for end-stage osteoarthritis were reviewed. The gender-specific prosthesis has a narrower mediolateral dimension. Patients were assessed for flexion, Oxford Knee Score, Knee Society function and knee scores, and Short Form–36 Health Survey preoperatively and postoperatively (at 6 months and 2 years).

Results.

The 2 groups were comparable in terms of age (67.8 vs. 68.1 years, p=0.789), body mass index (28.6 vs. 27.8 kg/m2, p=0.189), and preoperative scores. 12 women with conventional TKA and 4 women with gender-specific TKA were lost to follow-up. Compared with women with conventional TKA, women with gender-specific TKA had better flexion at 6 months (116° vs. 121.9°, p=0.007) and 2 years (118.7° vs. 124.6°, p=0.006), better bodily pain score at 2 years (65.1 vs. 72.4, p=0.049), and greater improvement in bodily pain score from baseline to 2 years (30 vs. 38.5, p=0.034).

Conclusion.

Gender-specific TKA enables better knee flexion and less bodily pain in women who have a high propensity to develop mediolateral overhang of the femoral component.
Intra-Articular Administration of Tranexamic Acid in Total Hip Arthroplasty
Authors: Chen Jerry Yongqiang , Lo Ngai Nung , Tay Darren Keng Jin , Chin Pak Lin , Chia Shi-Lu , Yeo Seng Jin
Published: October 2016

Purpose.

To evaluate the effectiveness of intra-articular tranexamic acid (TXA) in reducing blood loss and the need for blood transfusion during total hip arthroplasty (THA).

Methods.

Records of 19 men and 31 women aged 46 to 83 (mean, 62) years who underwent primary THA with intra-articular administration of TXA were reviewed. They were compared with a matched cohort of 17 men and 33 women aged 40 to 87 (mean, 62) years who underwent the same procedure by the same surgeon without use of TXA. Postoperatively, a standard thromboembolic prophylaxis protocol was followed. A serum haemoglobin level of <80 g/l was the trigger for blood transfusion.

Results.

The 2 groups were comparable in terms of age, gender, body mass index, side involved, and anaesthesia method. No patient developed infection, wound haematoma, symptomatic deep vein thrombosis, or pulmonary embolism within 30 days. Compared with controls, patients in the TXA group had a higher median postoperative serum haemoglobin level (103 vs. 112 g/l, p=0.013), lower median drop in serum haemoglobin level (31 vs. 20 g/l, p<0.001), lower median total blood loss (900 vs. 575 ml, p<0.001), and lower transfusion rate (32% vs. 10%, p=0.007). The TXA treatment cost S$19.50 per patient, whereas one unit of allogenic blood cost S$123 per patient. Respectively in the control and TXA groups, the mean cost per patient was S$39.36 and S$31.80, indicating a 19% difference.

Conclusion.

Intra-articular administration of TXA is a cost-effective and safe means to reduce blood loss and the need for blood transfusion during THA, without increasing the risk of thromboembolic events.
Stabilisation for the Disrupted Acromioclavicular Joint Using a Braided Polyester Prosthetic Ligament
Authors: Wright Jonathan , Osarumwense Donald , Ismail Fikry , Umebuani Yvonne , Orakwe Samuel
Published: October 2016

Purpose.

To report outcomes of 21 men who underwent stabilisation for the disrupted acromioclavicular joint (ACJ) using a braided polyester prosthetic ligament.

Methods.

21 men aged 23 to 76 (mean, 43) years underwent stabilisation for the disrupted ACJ of Rockwood type 3 (n=12), type 4 (n=1), and type 5 (n=8) using a braided polyester prosthetic ligament.

Results.

The mean time from injury to surgery was 6.8 (range, 0–19) months. The mean follow-up duration was 30 (range, 7–67) months. The mean Constant Score was 86.8 (range, 62–100), and the mean individualised Constant Score was 88.5 (range, 68–100). The mean Oxford Shoulder Score was 43.1 (range, 28–48). The mean abduction power of the operated side was 82% (range, 31%–97%) that of the normal side. 20 patients were satisfied with the procedure. One patient was dissatisfied who developed scapulothoracic bursitis. One patient required arthroscopic subacromial decompression for impingement. One patient sustained a redislocation following a fall at 6 weeks and declined further surgery.

Conclusion.

The braided polyester prosthetic ligament achieved good outcome for patients undergoing stabilisation for the disrupted ACJ.
Correlations between Three Patient-Assessed Shoulder Instability Scales
Authors: Taylor David , Garewal Devinder , Evans Matthew C
Published: October 2016

Purpose.

To evaluate the correlations between three patient-assessed shoulder instability scales before and after Latarjet stabilisation for traumatic antero-inferior glenohumeral instability.

Methods.

Records of 30 men and 2 women (mean age, 26.7 years) who had not undergone surgery for antero-inferior shoulder instability and records of 31 men and one woman (mean age, 27 years) who had undergone Latarjet stabilisation for antero-inferior shoulder instability and had been followed up for a mean period of 21.3 months were reviewed. Correlations between the Western Ontario Shoulder Instability Index (WOSI), the Melbourne Instability Shoulder Score (MISS), and the L'Insalata Shoulder Questionnaire (L'Insalata) were assessed.

Results.

The mean score of each scale was significantly greater in the postoperative than preoperative group (p<0.001). Within each group, the mean scores of the 3 scales differed significantly (ANOVA, p=0.001). The mean L'Insalata score was significantly higher than the mean WOSI and MISS scores (p<0.01, post-hoc analysis), but the latter 2 scores did not differ significantly (p>0.01, post-hoc analysis). Correlations of all scale pairs were significant (p<0.001). The WOSI-MISS correlations in the pre- and post-operative groups were moderate. The L'Insalata-WOSI correlations in the pre- and post-operative groups were moderate and high, respectively. The L'Insalata-MISS correlations in the pre- and post-operative groups were high and moderate, respectively.

Conclusion.

The MISS and WOSI scales are moderately correlated. Correlation of the L'Insalata scale with other scales depends on the operative status of the patient. The use of the L'Insalata scale alone is not recommended.
Percutaneous Release of Trigger Finger
Authors: Diab Ramy Ahmed
Published: October 2016

Purpose.

To evaluate the condition of the tendons and neurovascular bundles after percutaneous release for trigger finger of the middle, ring, and little fingers.

Methods.

30 women and 13 men aged 20 to 55 (mean, 40) years underwent percutaneous release of the A1 pulley using a 18-gauge needle for 43 trigger fingers of the middle, ring, or little finger unresponsive to conservative treatment. 19 trigger fingers were grade II and 24 were grade III. Open exploration was performed to evaluate the condition of the tendons and neurovascular bundles after percutaneous release.

Results.

Incomplete release of the A1 pulley was noted in 3 fingers, which occurred during the early study period. Superficial flexor tendon laceration was noted in 6 fingers but this did not interfere with tendon function. No injury to the A2 pulley, nerve, or artery of any finger was noted.

Conclusion.

Percutaneous release of trigger fingers is quick, safe, and effective.
Sciatic Nerve Schwannoma: A Case Report
Authors: Mansukhani Sameer Ajit , Butala Rajendraprasad R , Shetty Sunil H , Khedekar Ravindra G
Published: October 2016

We report on a 46-year-old woman with a sciatic nerve schwannoma. Magnetic resonance imaging revealed a well-defined, lobulated, intensely enhancing mass posterior to the left hip joint along the left sciatic nerve suggestive of neurogenic tumour. The Tinnel sign was positive on the posterior aspect of the left thigh. The tumour was excised without neural damage. Postoperatively, the patient showed no signs of any neurological deficit, and recovery was uneventful.
Spontaneous Disruption of the Bilateral Knee Extensor Mechanism: A Report of Two Cases
Authors: Seng Chusheng , Lim Yi-Jia , Pang Hee Nee
Published: October 2016

Spontaneous disruption of the knee extensor mechanism is associated with systemic diseases, steroid usage, and repeated microtrauma. Early repair or reconstruction is imperative for optimal outcome. We report 2 cases of spontaneous disruption of the bilateral knee extensor mechanism. The first patient had connective tissue disease and long-term steroid use. She had acute-on-chronic spontaneous bilateral patellar tendon rupture. She underwent reconstruction with an allograft and defunctioning wire. The second patient had end-stage renal failure with tertiary hyperparathyroidism and was on haemodialysis. He had a right patellar tendon rupture and a left quadriceps tendon rupture. He underwent primary repair of both tendons. Postoperatively, both patients followed a strict physiotherapy regimen and achieved good functional outcome.
Short Duration and Low Suction Pressure Drain versus No Drain following Total Knee Replacement
Authors: Lee Qunn Jid , Mak Wai Ping , Hau Wai Sun , Yeung Sze Tsun , Wong Yiu Chung , Wai Yuk Leung
Published: October 2016

Purpose.

To compare the short-term outcome in patients with or without a drain (short duration and low suction pressure) following total knee replacement (TKR).

Methods.

A consecutive series of 106 women and 48 men (mean age, 69 years) underwent unilateral TKR. The first 77 patients used a low suction pressure (200 mm Hg) drain following TKR for 24 hours, and the next 77 patients used no drain.

Results.

The 2 groups were comparable in terms of preoperative characteristics, the proportion of patients with pharmacological prophylaxis for deep vein thrombosis, the tourniquet time, and mode of anaesthesia. The mean drain output in the drain group was 221 ml. The time to achieve straight-leg-raising was earlier in the drain group (3.1 vs. 4.2 days, p<0.001).

Conclusion.

The use of a short duration, low suction pressure drain following TKR enabled an earlier return of quadriceps power, without increasing haemoglobin drop and transfusion rate.
Association of the Area of Sensory Disturbance with the Area of Suprascapular Nerve Palsy
Authors: Yoshioka Chika , Suenaga Naoki , Oizumi Naomi , Yamane Shintaro
Published: October 2016

Purpose.

To determine the association of the area of sensory disturbance with the area of suprascapular nerve (SSN) palsy in healthy volunteers and patients with SSN palsy.

Methods.

Five male and one female and healthy volunteers aged 23 to 44 (mean age, 32.2) years underwent an experiment of distal and proximal SSN block (at the spinoglenoid notch and suprascapular notch, respectively). A pinprick test was performed to determine pain sensation and the area of sensory disturbance. In addition, records of 21 male and 19 female patients aged 21 to 75 (mean, 54.1) years who underwent arthroscopic SSN release for SSN palsy were reviewed. The same pinprick test was performed.

Results.

After distal SSN block, 5 volunteers had a sensory deficit in the area below the scapular spine only, and one had no sensory deficit. After proximal SSN block, the sensory deficit spread to both lateral and medial sides above and below the scapular spine. In the 40 patients with SSN palsy, only 5 (12.5%) patients exhibited no sensory deficit above the scapular spine; 4 of them had ganglion cysts and one had entrapment of the nerve at the spinoglenoid notch. In 30 patients with palsy at the suprascapular notch, all had sensory deficit in the lateral side above the scapular spine. In 5 patients with ganglion and one patient with palsy at the spinoglenoid notch, sensory deficit was noted below (and not above) the scapular spine in all patients except for one.

Conclusion.

The area of sensory disturbance is associated with the area of SSN palsy.
Use of a Raft Construct through a Locking Plate without Bone Grafting for Split-Depression Tibial Plateau Fractures
Authors: Kulkarni Sunil G , Tangirala Ravishanker , Malve Shekhar P , Kulkarni Milind G , Kulkarni Vidisha S , Kulkarni Ruta M , Kriplani Suresh
Published: October 2016

Purpose.

To review the outcome after open reduction and internal fixation using a periarticular raft construct through a locking plate without bone grafting for split-depression tibial plateau fractures.

Methods.

Records of 38 knees in 31 men and 7 women aged 25 to 75 (mean, 42.7) years who underwent open reduction and internal fixation using a periarticular raft construct through a locking plate without use of a bone graft or bone substitute for split-depression (>5 mm) proximal tibial plateau fractures (Schatzker type II or AO/OTA type 4.1 B3) were reviewed. The integrity of the articular surface was assessed using radiographs. The Rasmussen radiological score and clinical score, the Lysholm knee score, and the Tegner activity score were also assessed.

Results.

The mean follow-up period was 22.8 (range, 6–36) months. All patients achieved bone union after a mean of 13.2 (range, 8–26) weeks. The mean range of motion was 118° (range, 100°–130°). The Rasmussen radiological score was excellent in 27 patients, good in 9, and fair in 2. The Rasmussen clinical score was excellent in 15 patients, good in 21, and fair in 2. The Lysholm knee score was excellent in 26 patients, good in 8, and fair in 4. 32 of the 38 patients recovered to their preoperative Tegner activity scores. Only one patient with severe comminution had loss of reduction after full weightbearing.

Conclusion.

Fixation using a periarticular raft construct through a locking plate without use of a bone graft or bone substitute for split-depression proximal tibial plateau fractures is a viable option.
Drilling the near Cortex with Elongated Figure-of-8 Holes to Reduce the Stiffness of a Locking Compression Plate Construct
Authors: Chen Jerry Yongqiang , Zhou Zhihong , Ang Benjamin Fu Hong , Yew Andy Khye Soon , Chou Siaw Meng , Chia Shi-Lu , Koh Joyce Suang Bee , Howe Tet Sen
Published: October 2016

Purpose.

To compare the stiffness of locking compression plate (LCP) constructs with or without drilling the near cortex with elongated figure-of-8 holes.

Methods.

24 synthetic bones were sawn to create a 10-mm gap and were fixed with a 9-hole 4.5-mm narrow LCP. In 12 bones, the near cortex of the adjacent holes to the LCP holes was drilled to create elongated figure-of-8 holes before screw insertion. The stiffness of LCP constructs under axial loading or 4-point bending was assessed by (1) dynamic quasi-physiological testing for fatigue strength, (2) quasi-static testing for stiffness, and (3) testing for absolute strength to failure.

Results.

None of the 24 constructs had subcatastrophic or catastrophic failure after 10 000 cycles of fatigue loading (p=1.000). The axial stiffness reduced by 16% from 613±62 to 517±44 N/mm (p=0.012) in the case group, whereas the bending stiffness was 16±1 Nm2 in both groups (p=1.000). The maximum axial load to catastrophic failure was 1596±84 N for the control group and 1627±48 N for the case group (p=0.486), whereas the maximum bending moment to catastrophic failure was 79±12 and 80±10 Nm, respectively (p=0.919).

Conclusion.

Drilling the near cortex with elongated figure-of-8 holes reduces the axial stiffness of the LCP construct, without compromising its bending stiffness or strength.
Treatment for Spondylolysis and Spondylolisthesis in Children
Authors: Leonidou Andreas , Lepetsos Panagiotis , Pagkalos Joseph , Antonis Konstantinos , Flieger Ioannis , Tsiridis Eleftherios , Leonidou Omiros
Published: October 2016

Purpose.

To review outcome of 44 children who underwent conservative or surgical treatment for spondylolysis or spondylolisthesis.

Methods.

Records of 25 male and 19 female children aged 5 to 14 (mean, 10.2) years who underwent conservative (n=39) or surgical (n=5) treatment for spondylolysis (n=19) or spondylolisthesis (n=25) were reviewed. Conservative treatment involved application of a thoracolumbosacral orthotic brace for all day except bedtime until symptoms resolved and then physiotherapy including exercises to strengthen the abdominal and back muscles and stretching exercises of the hamstrings and hip flexors. Surgery (instrumented posterolateral fusion [n=4] or Wiltse posterolateral fusion [n=1]) with allografts was indicated in patients with refractory pain (n=2) or nerve root irritation (n=1) and in patients with iatrogenic spondylolisthesis (n=2), followed by application of the brace for 3 months and then physiotherapy. Outcome was assessed using the Seitsalo scoring system.

Results.

The mean follow-up period was 6.5 (range, 3–10) years. No patient developed any postoperative complication. Outcome was excellent in 35 patients, good in 8, and fair in one. All 5 patients who underwent posterolateral fusion for refractory spondylolisthesis achieved good outcome. In 11 patients with spondylolysis, the pars defect healed. None of the spondylolysis progressed to spondylolisthesis. All displacements remained stable, without any progression.

Conclusion.

Conservative treatment is effective for most patients with spondylolysis or spondylolisthesis. Instrumented posterolateral fusion is indicated in patients with persistent symptoms and for iatrogenic cases.
Special Article: Update on the Magnetically Controlled Growing Rod: Tips and Pitfalls
Authors: Cheung Jason Pui Yin , Cahill Patrick , Yaszay Burt , Akbarnia Behrooz A , Cheung Kenneth MC
Published: October 2016

Magnetically controlled growing rods (MCGR) have become an important treatment option in young patients with spinal deformities. This device allows for gradual lengthening on an outpatient setting with continuous neurological monitoring in an awake patient. With its growing popularity and interest, this study reports the tips, pitfalls, and complications of the MCGR for management of scoliosis. On 3 June 2015 at the University of Hong Kong, 32 participants from 16 regions shared their experience with MCGR. Current indications for surgery include early-onset scoliosis patients. Adolescent idiopathic scoliosis and congenital scoliosis patients have less favourable outcomes. The number of instrumented levels should be minimised, as all instrumented levels must be included in the definitive fusion surgery. Rod contouring is important and owing to the straight portion of the rod housing the magnet, there is limited proximal rod portion for proper contouring, which may predispose to proximal junctional kyphosis. There is currently no consensus on the rod configuration, timing, frequency, technique, and amount of distraction. Risk factors for distraction failure include larger patients, internal magnets too close to each other, and magnets too close to the apex of the major curve. Future studies should resolve the issues regarding the technique of distraction, optimal frequency and amount of distraction per session. More comprehensive cost analyses should be performed.
Review Article: Surgical Approaches for Correction of Post-Tubercular Kyphosis
Authors: Panchmatia Jaykar R , Lenke Lawrence G , Molloy Sean , Cheung Kenneth MC , Kebaish Khaled M
Published: October 2016

This study reviewed the literature regarding the pros and cons of various surgical approaches (anterior, anterolateral, combined, and posterior) for correction of post-tubercular kyphosis. The anterior and anterolateral approaches are effective in improving neurological deficit but not in correcting kyphosis. The combined anterior and posterior approach and the posterior approach combined with 3-column osteotomy achieve good neurological improvement and kyphosis correction. The latter is superior when expertise and facilities are available.
Shoulder Tuberculosis in Children: A Report of Two Cases
Authors: Agarwal Anil , Kumar Anubrat , Shaharyar Abbas , Bhat Mohd Shafi
Published: October 2016

We report 2 children who underwent multidrug antituberculous therapy with rifampicin, isoniazid, ethambutol, and pyrazinamide followed by dedicated physiotherapy for tuberculosis of the shoulder. Both patients regained a range of motion comparable with the contralateral side after 9 to 10 months.
Novel Stress Radiography Technique for Avulsion Fracture of the Lateral Malleolus in Children: A Report of Three Cases
Authors: Iwata Yasuo
Published: October 2016

This study reports a novel stress radiography technique to evaluate an avulsion fracture at the lateral malleolus in children. Radiographs in the stress anteroposterior view or the Haraguchi calcaneofibular ligament or anterior tarofibular ligament (ATFL) projection could not detect any fracture; only manual inversion stress radiography in the Haraguchi ATFL projection could identify the avulsion fracture.
Functional Outcomes After Double-Row Versus Single-Row Rotator Cuff Repair
Authors: Nicholas Stephen J. , Lee Steven J. , Mullaney Michael J. , Tyler Timothy F. , Fukunaga Takumi , Johnson Christopher D. , McHugh Malachy P.
Published: October 2016

Background:

The functional benefits of double-row (DR) versus single-row (SR) rotator cuff repair are not clearly established.

Purpose:

To examine the effect of DR versus SR rotator cuff repair on functional outcomes and strength recovery in patients with full-thickness tears.

Study Design:

Randomized controlled trial; Level of evidence, 2.

Methods:

Forty-nine patients were randomized to DR or SR repairs; 36 patients (13 women, 23 men; mean age, 62 ± 7 years; 20 SR, 16 DR) were assessed at a mean 2.2 ± 1.6 years after surgery (range, 1-7 years; tear size: 17 medium, 13 large, 9 massive). The following data were recorded prior to surgery and at follow-up: Penn shoulder score, American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) results; range of motion (ROM) for shoulder flexion, external rotation (ER) at 0° and 90° of abduction, and internal rotation (IR) at 90° of abduction; and shoulder strength (Lafayette manual muscle tester) in empty- and full-can tests, abduction, and ER at 0° of abduction. Treatment (SR vs DR) × time (pre- vs postoperative) mixed-model analysis of variance was used to assess the effect of rotator cuff repair.

Results:

Rotator cuff repair markedly improved Penn, ASES, and SST scores ( P < .001), with similar improvement between SR and DR repairs (treatment × time, P = .38-.10) and excellent scores at follow-up (DR vs SR: Penn, 91 ± 11 vs 92 ± 11 [ P = .73]; ASES, 87 ± 12 vs 92 ± 12 [ P = .21]; SST, 11.4 ± 1.0 vs 11.3 ± 1.0 [ P = .76]). Patients with DR repairs lost ER ROM at 0° of abduction (preoperative to final follow-up, 7° ± 10° loss [ P = .013]). ER ROM did not significantly change with SR repair (5° ± 14° gain, P = .16; treatment by time, P = .008). This effect was not apparent for ER ROM at 90° of abduction (treatment × time, P = .26). IR ROM improved from preoperative to final follow-up ( P < .01; SR, 17° ± 27°; DR, 7° ± 21°; treatment × time, P = .23). Rotator cuff repair markedly improved strength in empty-can (54%), full-can (66%), abduction (47%), and ER (54%) strength (all P < .001), with no difference between SR and DR repairs ( P = .23-.75). All clinical tests with the exception of the lift-off test were normalized at follow-up ( P < .05).

Conclusion:

Outcomes were not different between SR or DR repair, with generally excellent outcomes for both groups. Rotator cuff repair and subsequent rehabilitation markedly improved shoulder strength.
The Prediction of Speech Recognition in Noise With a Semi-Implantable Bone Conduction Hearing System by External Bone Conduction Stimulation With Headband
Authors: Ihler Friedrich , Blum Jenny , Berger Max-Ulrich , Weiss Bernhard G. , Welz Christian , Canis Martin
Published: October 2016

Semi-implantable transcutaneous bone conduction devices are treatment options for conductive and mixed hearing loss (CHL/MHL). For counseling of patients, realistic simulation of the functional result is desirable. This study compared speech recognition in noise with a semi-implantable transcutaneous bone conduction device to external stimulation with a bone conduction device fixed by a headband. Eight German-language adult patients were enrolled after a semi-implantable transcutaneous bone conduction device (Bonebridge, Med-El) was implanted and fitted. Patients received a bone conduction device for external stimulation (Baha BP110, Cochlear) fixed by a headband for comparison. The main outcome measure was speech recognition in noise (Oldenburg Sentence Test). Pure-tone audiometry was performed and subjective benefit was assessed using the Glasgow Benefit Inventory and Abbreviated Profile of Hearing Aid Benefit questionnaires. Unaided, patients showed a mean signal-to-noise ratio threshold of 4.6 ± 4.2 dB S/N for speech recognition. The aided results were −3.3 ± 7.2 dB S/N by external bone conduction stimulation and −1.2 ± 4.0 dB S/N by the semi-implantable bone conduction device. The difference between the two devices was not statistically significant, while the difference was significant between unaided and aided situation for both devices. Both questionnaires for subjective benefit favored the semi-implantable device over external stimulation. We conclude that it is possible to simulate the result of speech recognition in noise with a semi-implantable transcutaneous bone conduction device by external stimulation. This should be part of preoperative counseling of patients with CHL/MHL before implantation of a bone conduction device.
All-Arthroscopic AMIC for Osteochondral Lesions of the Talus
Authors: Manzi Luigi , D’Ambrosi Riccardo , Maccario Camilla , Girolamo Laura De , Usuelli Federico G.
Published: October 2016

Category:

Arthroscopy.

Introduction/Purpose:

Autologous Matrix-Induced Chondrogenesis (AMIC) technique has shown to provide satisfactory clinical results for the treatment of knee, hip and ankle cartilage lesions. The purpose of this study is to evaluate clinical and radiological outcomes of patients treated with a new All-arthroscopic AMIC (A-AMIC) technique for osteochondral defects of the talus at a minimum follow-up of 24 months (mean f.up, 41 months).

Methods:

20 patients underwent A-AMIC procedure for type III and IV osteochondral lesions of the talus. Patients were evaluated pre-operatively and at 6, 12 and 24 months post-operatively using AOFAS score (American Orthopaedic Foot and Ankle Society), VAS (Visual Analog Scale) and SF-12 (Short Form -12). Radiological assessment included CT-Scan and MR.

Results:

All the scores significantly improved with respect to pre-operative values already after 6 months, with further improvements up to 24 months (AOFAS, from 57.1±14.9 before surgery to 86.6±10.9 after 24 months; VAS, from 8.1±1. to 2.5±2.2; SF-12, from 29.9±4.1 to 48.5±6.9 and from 43.8±2.9 to 53.1±3.9 respectively for PCS and MCS). Lesion size volume significantly reduced from 810±536.3 mm3 pre-operatively to 453±310.6 mm3 at final follow-up as assessed by CT-scan, and from 1251 mm3 to 489 mm3 as assessed by MR. MOCART score (magnetic resonance observation of cartilage repair tissue) was 42.8±22.9 and 50.9±24.9 at 12 and 24 months, respectively.

Conclusion:

Our study demonstrates that A-AMIC can be considered a safe, scarcely invasive and effective technique able to rapidly and significantly improve pain and function and radiological healing of lesions, with progressive further improvements at least up to 24 months.
STAR™ Ankle
Authors: Palanca Ariel , Mann Roger A.
Published: October 2016

Category:

Ankle Arthritis.

Introduction/Purpose:

Over the past decade, total ankle arthroplasty (TAA) has become a mainstay in the treatment of end stage ankle arthritis. Currently in its fourth generation, the Scandanavian Total Ankle Replacement (STAR™) is the only 3-piece mobile bearing design available in the United States. Current studies show 89-94% survivorship of the STAR™ at 9-12 years follow-up. We report patient outcomes at a minimum of 15 years.

Methods:

24 patients from the initial U.S. STAR™ FDA trial who had undergone no metal revision at 10 year follow-up were available for participation. Radiographic examinations were performed for all patients. Changes in prosthetic position, coronal and sagittal plane alignment, osteolysis, adjacent joint arthritis, and heterotopic ossification were documented. Clinical examinations were performed for 14 patients. Clinical findings, AOFAS ankle/hindfoot scores and SF-36 scores were recorded. All secondary procedures and complications were noted. Implant failure was defined as revision or explant of either the tibial or talar component.

Results:

87.5% (21/24) of participants had metal survivorship at a minimum of 15 years. Two patients required revision surgery for aseptic loosening and one required a tibiotalocalcaneal fusion for a progressive coronal plane deformity. Of the 21 patients with metal survivorship, the AOFAS ankle/hindfoot rating scale improved from an average of 39.6 points preoperatively, to an average of 71.6 points at latest follow up (range 42-89). The average SF-36 score was 49.0. Postoperative range of motion averaged 17 degrees (range 5-30°). Adjacent joint arthritis was seen radiographically in 5 patients (23.8%), one which required a subtalar fusion. Two patients required exchange for a broken polyethylene spacer. 11/21 (52.4%) of patients required an additional surgical procedure, 3 of whom required two additional procedures. Average time to subsequent procedure was 10.2 years.

Conclusion:

Our data shows that if the STAR™ ankle has survived for 10 years, it will likely survive for 15 years. On the whole, patients reported good subjective outcomes, maintaining a near 30 point improvement in AOFAS scores. Revisions after 10 years were seen for aseptic loosening and coronal plane deformity. Patients should be counseled that it is common to have a subsequent procedure, which averaged 10 years postoperative from our experience. Further advancement in instrumentation, polyethylene wear characteristics, and revision implants will likely be the next stage in the advancement of TAA.
What Variables Influence Final Range of Motion Following Total Ankle Arthroplasty
Authors: Lee Wei Ting , Myerson Mark S. , Grosshans Kevin T.
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

While studies have demonstrated a predictable incremental increase in the range of motion (ROM) following total ankle arthroplasty (TAA) it remains unclear what variables affect the post-operative ROM. This study was undertaken to further investigate this question with the goal of providing guidance for patients and surgeons deciding between TAA and arthrodesis.

Methods:

This is a prospective review of 223 consecutive patients who underwent primary TAA using a single prosthesis performed between 2010-2013 for painful ankle arthritis that failed conservative therapy. Weight bearing flexion and extension X- rays were obtained preoperatively and again at 1 year following surgery. The patients were compared for demographics, type of arthritis, preoperative malalignment, prior trauma, obesity, medical co-morbidities, and the effect of concurrent surgery on post operative ankle ROM.

Results:

191 patients had adequate follow-up and met all the inclusion criteria. The preoperative diagnosis, hindfoot or ankle varus or valgus, and concurrent percutaneous tendon Achilles lengthening (TAL) procedures were positive predictors of greater improvement in ankle ROM after TAA. Patients with valgus ankle malalignment had better post TAA DF, PF and total ankle range of motion compared to those in varus (P < 0.05). Percutaneous tendon Achilles lengthening (TAL) improved the DF, but not the PF (P < 0.05). Patients with primary ankle osteoarthritis (n=105) had the best improvement in ROM with an average gain of 3.39° in dorsiflexion (DF), 2.47° in plantar flexion (PF) and 5.84° in total ankle ROM (P < 0.05). An analysis of this subgroup demonstrated greater gain in ankle ROM in patients with lower preoperative ROM compared to those with higher preoperative ankle ROM(P < 0.01).

Conclusion:

Our results indicated primary ankle OA, preoperative ankle valgus malalignment and intraoperative TAL are significant factors in predicting increased ankle ROM after TAA. Ultimately, ankle motion is a function of the extent of arthritis, fibrosis and the surrounding soft tissue envelope. While TAA restores the function of the joint, it may not adequately correct periarticular fibrosis. Early weight bearing and physical therapy may alleviate postoperative stiffness, and increase the post operative gain in ROM. Further study is underway to determine the effect of early weight bearing and initiation of physical therapy on the ROM following TAA.
A Retrospective Study
Authors: Smith Kenneth S. , Jones Caleb W. , Elattar Osama , Shah Ashish
Published: October 2016

Category:

Ankle

Introduction/Purpose:

Tibiotalocalcaneal arthrodesis (TTCA) is a salvage procedure for end-stage pathology of the tibiotalar and subtalar joints including primary arthritis, severe deformity, failed total ankle arthroplasty, failed ankle arthrodesis with subsequent subtalar arthritis, talus avascular necrosis and Charcot arthropathy. Although many different fixation techniques of TTCA have been proposed, there is still no consensus gold standard fixation strategy. The various options include plate and screw constructs, intramedullary nails and external fixator systems. The purpose of this study is to report our experience with rigid fixation using a commercially available 4.5 mm locking plate for TTCA.

Methods:

We retrospectively reviewed the clinical charts and radiographs of 17 patients who underwent TTCA during the time period of 2012-2014. We used a lateral surgical approach with fibular osteotomy and a 4.5 mm Smith and Nephew™ PERI-LOC ankle fusion plate. Two senior foot and ankle surgeons at our institution performed all surgeries. The main outcomes were postoperative fusion rate and complication rate.

Results:

Of the 17 patients, 9 were male and 8 were female with a mean age of 53. 29% of patients had diabetes mellitus and 69% were either current or former smokers. The average BMI was 32.9. The average follow up was 17.7 months. The nonunion rate in our patient series was 76%. Nonunion was defined as no radiographic evidence of fusion at 6 months post-surgery. This failure rate is very high in comparison to historical data of nonunion rates in TTCA, which are often reported to be 7-26%. Only four out of 17 patients had a successful arthrodesis using this locked plate construct. Complications included nonunion, hardware failure (with screws and/or plate fracture), deep infection (35% of patients), and pseudoarthrosis.

Conclusion:

Too rigid of fixation with thick stainless steel plates and locking screw constructs can lead to failure in tibiotalocalcaneal arthrodesis. Increased nonunion rates due to overly rigid fixation has been demonstrated in many other contexts but never in the foot and ankle literature.