bluuebunny/crossref_metadata_2025 huggingface dataset:
The Need to Improve and Integrate Science and Environmental Licensing to Mitigate Wildlife Mortality on Roads in Brazil
Authors: Teixeira Fernanda Zimmermann , Coelho Igor Pfeifer , Lauxen Mozart , Esperandio Isadora Beraldi , Hartz Sandra Maria , Kindel Andreas
Published: October 2016

The ongoing expansion of the transportation network is one of the most important threats to tropical ecosystems. In recent years, the Brazilian government is making huge investments in paving and upgrading of the existing road network. It is therefore crucial time to consider how to achieve mitigation of two main road impacts: wildlife mortality and isolation. We discuss the improvement of road ecology research and environmental impact assessments, and recommend the integration of both as a way to achieve effective mitigation. Research oriented toward practical needs is likely to increase use of road ecology in decisions about the impacts of roads and traffic, including the environmental licensing of roads. Well-planned, focused assessments can effectively influence road planning. However, merely improving environmental assessments and research will not be enough to make environmental licensing more effective: there is a need for integration among professions involved in road construction, biodiversity management and conservation for better regulations and enforcement.
The Ecology of Human-Anaconda Conflict: A Study Using Internet Videos
Authors: Miranda Everton B. P. , Ribeiro Raimundo P. , Strüssmann Christine
Published: October 2016

Human-wildlife conflict is a widespread problem that threatens both animals and local livelihoods. When this conflict involves predators, the additional risks to human life worsen the problem. The perceptions of human-predator conflict have been investigated multiple times, usually to generate data for conflict resolution. However, such efforts have largely involved mammals from the order Carnivora. In this work, we tested hypotheses about the feeding habits of two species of constricting anacondas from the genus Eunectes and human perception of risks and attitudes associated with such habits. In particular, we investigated the consequences for the snake after predation on domestic or wild animals. We also tested the relationship between human killing of anacondas and local development indicators – a proxy for general education level. Data were obtained from internet videos using a standardized method for information retrieval. A total of 330 videos of human-anaconda encounters were recovered from ten different South American countries. We found that visual evidence of a recent meal (distended abdomen) and predation on domestic animals did not affect the probability of the anaconda being killed, but this probability increased as the Human Development Index (HDI) diminished and as anaconda size increased. Although retaliatory killing is described as one of main causes of animal mortality following human-wildlife conflicts, our results suggest that killing of anacondas are not retaliatory or related to economic losses, but preventive, because these snakes are seen as life-threatening animals. Adding social context information on human-predator conflicts, together with taxon-free research on this subject can improve our knowledge about human-wildlife conflict. Further research could focus on the actual impacts (direct or indirect) of anacondas on stakeholders, and on the role of other non-mammalian predators in human-wildlife conflicts (whether actual or perceived).
Temporal Variation in the Diversity of Cantharidae (Coleoptera), in Seven Assemblages in Tropical Dry Forest in Mexico
Authors: Hernández Cisteil Xinum Pérez , Caballero Santiago Zaragoza
Published: October 2016

One aspect of cantharids that has received little attention is the analysis of temporal diversity patterns. For an approximation to this aspect, temporal variation in richness, abundance and temporal turnover in monthly species composition were analyzed for seven assemblages of Cantharidae associated to the Tropical Dry Forest (TDF), in Mexico. A search was also made for processes associated. High species richness and abundance for the rain season, high dissimilarity among the months of the inter-seasonal period, and common patterns of diversity in the assemblages, regardless of the species they included, were expected. The seven assemblages clearly displayed a seasonal pattern of abundance associated with the rain season, but the total expression of seasonality in each assemblage was determined by asynchronous emergence of genera and species, in addition to high temporal turnover in species composition. With few exceptions, abundance, richness and temporal turnover showed statistically significant correlation with variation in precipitation; temperature had apparently little or no influence. The results suggest that adult emergence could be determined by host plant phenology and, indirectly, by abiotic factors such as precipitation. The importance of conducting more comprehensive studies to provide accurate evidence to characterize temporal patterns of diversity in TDF insect assemblages and associated processes, not just indicating the presence-absence of species at given times and places is emphasized.
Patterns of Species Diversity are not Consistent between Shifting Cultivation in Bawangling Nature Reserves and Selective Logging in Diaoluoshan Nature Reserves, Hainan Island, China
Authors: Lin Deng , Jiang Yong , Zang Runguo , Wang Xu , Long Wenxing , Huang Jin , Kang Yong , Wang Xixi , Xie Zhixu
Published: October 2016

Examining changes in plant species diversity after shifting cultivation and logging has taken place in a system can help generate an understanding of the differences in species' responses to these human disturbances. We established 17 plots (each 0.25 hm2) in young, middle-aged and old-growth forests (i.e. three recovery stages) in Bawangling and Diaoluoshan on Hainan Island, China, after shifting cultivation and selective logging had taken place. We divided each plot into four vertical communities. Changes in the species diversity of each plot (i.e. the overall community) and within the vertical communities were assessed across the three recovery stages. Results showed that, after shifting cultivation, species diversity increased across the three recovery stages for the overall community and for the four vertical communities. Species abundance decreased for the overall community but change was inconsistent for the four vertical communities. After selective logging, however, there was generally little change in species diversity and abundance across the three recovery stages, either overall or within the vertical communities. This suggests that patterns of species diversity between communities are different after shifting cultivation has occurred and when selective logging has taken place. Furthermore, Non-Metric Multidimensional Scaling showed differences in species composition across the three stages in the four vertical communities after shifting cultivation, but no differences in species composition across the three stages after selective logging. We also divided species dissimilarity coefficients into two parts, showing changes in species composition and abundance between the vertical communities under canopies and the canopy communities. We found that after shifting cultivation the coefficients between young-aged and old-growth forests, and middle-aged and old-growth forests were more than 0.77, but that they did not differ after selective logging had occurred. This suggests that changes in species turnover is unpredictable after shifting cultivation, but predictable after selective logging.
Floristic Composition and Edge-Induced Homogenization in Tree Communities in the Fragmented Atlantic Rainforest of Rio De Janeiro, Brazil
Authors: Thier Oliver , Wesenberg Jens
Published: October 2016

This study investigates the changes of tree species composition and diversity along the gradient from fragment edge to interior, and between edge and interior habitats, on a regional scale, in nine Atlantic forest fragments (6–120 ha), in southeastern Brazil. A total of 1980 trees (dbh ≥ 5 cm) comprising 252 species, 156 genera and 57 families were surveyed using the point-centered quarter method. From the fragment edge towards the interior the proportion of shade-tolerant trees increased continuously. The majority of all trees within the first 100 m from the edge belonged to the pioneer-guild. Floristic dissimilarity was found to be higher among interior habitats of different fragments than among the corresponding edge areas or among different small fragments. Species diversity increased along the edge-interior gradient 1.5 times within the first 250 m. Our results support previous findings that the establishment of edge-affected habitats leads to tree species impoverishment and homogenization via the dominance and proliferation of pioneer species in the forest edges of severely fragmented tropical landscapes. We argue that conservation strategies which include the creation of buffer zones between forest edges and the matrix will be more efficient than the establishment of narrow corridors to connect fragments and protected areas.
Strenuous Walking Exercise and Spontaneous Fracture of the Femoral Neck in the Elderly
Authors: Moon Myung-Sang , Kim Sung-Sim , Moon Jeong-Lim , Moon Young-Wan
Published: October 2016

Spontaneous fractures of the hip which developed after strenuous walking exercise in 8 elderly people are reported. All patients had Singh hip index 4 or below at the time of initial examination and walked from 8,000 to 10,000 steps per day. This presentation aims to arouse the attention of physicians, recreational sports coaches, and elderly people to the deleterious effects of strenuous walking exercise on bone, and it looks for an optimal level of walking exercise according to the elderly patient's bone quality. Walking exercise should be stopped immediately if pain in the hip develops and continues without relief for several days or more. The optimal walking frequency per day should be prescribed on the basis of the Singh index or T-score of BMD. If the BMD is 1/3 to 1/2 of normal, walking frequency should be adjusted to 1/3 to 1/2 of those of the normal adult with good bone quality.
Osteoporosis: A Possible Aetiological Factor in the Development of Scheuermann's Disease
Authors: Ashton L Andrew , Stephen J , Nabavi-Tabrizi A , Bleasel J , Briody J
Published: October 2016

The aim of this study was to test the hypothesis that spinal osteoporosis is an aetiological factor in the development of Scheuermann's disease in adolescents. Clinical and radiological data was collected on 12 individuals with Scheuermann's disease (SD). Lumbar spine bone mineral density (L2–4) was measured using dual energy X-ray absorptiometry. Age and sex-matched adolescents were used as controls. The number of standard deviations from the mean of age and sex-matched controls were calculated. In regards to results, SD patients demonstrated high bone densities of between 1 and 1.5 standard deviations above the mean of age-matched controls. These results suggest that osteoporosis is not an aetiological factor in Scheuermann's disease and that bone density measurements may indeed be higher than aged-matched controls in the general population.
Early Results of Posterior-Stabilised NexGen Legacy Total Knee Arthroplasty
Authors: Ip D , Wu WC , Tsang WL
Published: October 2016

Objective.

To retrospectively assess the early results of the NexGen Legacy posterior-stabilised total knee prosthesis, which is a newer version of the Insall-Burstein II posterior-stabilised implant.

Methods.

48 consecutive elderly patients had 60 NexGen Legacy posterior-stabilised total knees. The mean follow-up duration was 21 months. Clinical evaluation was performed according to the Knee Society scores and a scoring system for patellofemoral articulation; radiographic assessment followed the guidelines of the Knee Society. Special emphasis was given to any patellofemoral complications, such as patellar clunk syndrome, patellar maltracking, and other disorders of the extensor mechanism.

Results.

Only one patient had mild patellofemoral anterior knee pain at the latest follow-up; 2 patients had patellofemoral crepitus but no pain. No patellar clunk or any other complication of the patellofemoral articulation, such as patellar fracture or subluxation was found. The mean preoperative and postoperative Knee Society scores were 60 and 85 respectively. The mean postoperative knee flexion was 115°.

Conclusion.

The overall early results from using the new implant were good, probably because of changes in design of the intercondylar box and its associated cam-and-post mechanism, and a more anatomic trochlea surface, so that the trochlea accommodates the natural patella.
Quantitative Anatomic Characterisation of the Pelvic Brim to Facilitate Internal Fixation through an Anterior Approach
Authors: Shiramizu K , Naito M , Yatsunami M
Published: October 2016

Purpose.

To define the centre of the hip joint and the bone stock around the hip joint from the supra-acetabular portion or pelvic brim so as to avoid penetration of guidewire into the hip joint when performing internal fixation using the anterior approach.

Methods.

A total of 42 cadavers were utilised. Measurements were completed before and after cutting the pelvis into 4 pieces. Before cutting the pelvis, the centre of the hip joint was measured on the pelvic brim. After cutting the pelvis, the bone stock around the hip joint was measured in each section. The pelvic brim and the anteroinferior iliac spine were utilised as guide points in the measurements, because these parameters could be determined during an anterior surgical procedure.

Results.

On the pelvic brim, the reflected centre of the hip joint centre was located approximately 3.2 mm anterior to the distal edge of the anteroinferior iliac spine. The mean minimum bone stock of the pelvic brim was 14.0 mm in the centre of the hip joint section.

Conclusion.

This study described the anatomical reference points around the hip joint, and the ways in which they can be utilised to increase the safety of the anterior approach for internal fixation. It is important to define the centre of the hip joint from the supra-acetabular portion or pelvic brim, given that it is not visualised during surgery using an anterior approach.
Midshaft Clavicular Non-Unions Treated with the Herbert Cannulated Bone Screw
Authors: Proubasta IR , Itarte JP , Lamas CG , Cáceres E
Published: October 2016

Purpose.

To assess an alternative technique for the treatment of midshaft non-unions of the clavicle.

Methods.

Five patients with symptomatic non-unions of the clavicle were treated with open reduction and intramedullary fixation by using a Herbert cannulated bone screw. Autogenous bone grafting was applied in one case and decortication in the other 4 cases.

Results.

Review of the clinical and radiological documentation at a mean time of 13 months (range, 9–26 months) postoperatively shows that union was achieved in all 5 cases. There were no complications related to the operation, and no patient needed removal of the implant for protrusion, loosening, or any other cause.

Conclusion.

Midshaft non-unions of the clavicle can be treated successfully using the Herbert cannulated bone screw, which avoids the need for a second operation to remove the implant after bone union.
Profile of Bilateral Anterior Cruciate Ligament Injuries: A Retrospective Follow-up Study
Authors: Motohashi M
Published: October 2016

Purpose.

To assess the mechanism of injury of anterior cruciate ligaments, surgical results, and radiographic findings among patients with bilateral knee injuries, and to compare these features with those of patients sustaining unilateral injuries.

Methods.

From 1977 to 1988, among 458 patients with injury of anterior cruciate ligament operated in our hospital, 11 were of bilateral injury, in whom 10 could be followed up. A laxity score was calculated to evaluate laxity of 7 joints. A notch width index was measured to show the narrowing of femoral notch.

Results.

The mean follow-up duration was 3 years 3 months. All 10 patients with bilateral injury of anterior cruciate ligaments were female, and 90% had non-contact injuries. The mean (standard deviation) laxity score was significantly higher in the bilateral injury group than in the unilateral injury group (3.3 [1.4] versus 2.2 [1.4] points; p<0.05). The mean notch width index was significantly lower in the bilateral injury group than in the healthy group (0.278 [0.025] versus 0.294 [0.031]; p<0.05). The mean age at the time of the first injuries was significantly lower among the bilateral injury group than among the unilateral injury group (16.6 [2.1] years versus 19.8 [6.1]; p<0.05). The level of return to full sporting activities was low in the bilateral group.

Conclusion.

These results suggest that several factors are involved in the occurrence of the anterior cruciate injuries. Besides being younger at the time of the first injury, patients in bilateral injury group had higher mean laxity score and lower mean notch width index than unilateral injury group. Most of the injuries in bilateral group were of non-contact type.
The Management of Superior Dislocation of the Patella with Interlocking Osteophytes—An Update on a Rare Problem
Authors: Yip DKH , Wong JWK , Sun LK , Wong NM , Chan CW , Lau PY
Published: October 2016

The superior dislocation of the patella with interlocking osteophytes is a rare condition. A review of the English literature revealed only 12 reported cases. The purpose of reviewing these case reports is to highlight the unusual presentation and the injury mechanism in 2 of our patients, and to present our treatment algorithm. Closed reduction with manipulation of the patella, with or without anaesthesia, was performed without difficulty. We recommend an intermediate step of trying a regional nerve block before proceeding to general anaesthesia. Our patients had full range-of-motion after reduction and they were symptom-free after 3 years of follow-up. There were no recurrent dislocations in our patients.
Iatrogenic Calcinosis Cutis—A Rare Differential Diagnosis of Soft-Tissue Infection in a Neonate: A Case Report
Authors: Arora A , Agarwal A , Kumar S , Gupta SK
Published: October 2016

This case report describes a rare differential diagnosis of soft-tissue infection in a neonate. Fever, pain, inflammation, and acute tenderness in the limb of a neonate signify acute infection or osteomyelitis unless proved otherwise. Iatrogenic calcinosis cutis presents with similar symptoms and signs; its diagnosis may be easily confused with an infective condition by an unwary orthopaedic surgeon. This report aimed to raise doctors' awareness on the presentation, aetiopathogenesis, and course of the relatively rare iatrogenic calcinosis cutis.
Prognosis of Proximal Femoral Fracture in Patients Aged 90 Years and Older
Authors: Hagino T , Maekawa S , Sato E , Bando K , Hamada Y
Published: October 2016

Purpose.

To examine the walking ability and survival outcome of patients aged 90 years and older who sustained proximal femoral fractures, and to compare the findings with those of younger patients reported in previous studies.

Methods.

Between January 1997 and June 2004 inclusive, 56 patients (11 men and 45 women) aged 90 years and older (range, 90–103 years; mean, 93 years) with hip fracture were reviewed. Their walking ability and survival outcome at discharge was investigated. Comparison was made between patients aged 60 to 89 years and those aged 90 years and older with respect to sex, fracture type, and other characteristics.

Results.

Of 56 patients, 26 injured the right side and 30 the left side. Before injury, 33 (59%) were living at home and 23 (41%) were institutionalised in long-term care facilities or other hospitals. Fracture occurred at the femoral neck in 14 patients and at the trochanter in 42. Ten patients were treated conservatively because of severe dementia, comorbidity, or refusal of surgery by the patients or their families, whereas 46 underwent surgery. Of the 45 who were previously ambulatory, 22 regained walking ability on discharge from hospital. None of the 10 patients treated conservatively were ambulatory on discharge. During hospitalisation, 4 became bedridden and 5 died (mainly due to pneumonia); among these 9 patients, 5 were deemed physically unfit for surgery.

Conclusion.

Surgery is the treatment of choice for patients aged 90 years and older with proximal femoral fracture. However, they have a lower rate of regaining pre-injury walking ability and a higher in-hospital death rate than younger patients.
The Usefulness of Computed Tomography following Open Reduction and Internal Fixation of Acetabular Fractures
Authors: O'Shea K , Quinlan JF , Waheed K , Brady OH
Published: October 2016

Purpose.

To investigate the role of a supplemental imaging modality in postoperative assessment of acetabular fractures following open reduction and internal fixation.

Methods.

Postoperative axial computed tomographic (CT) scans were compared with plain radiographs of 20 patients with regard to their sensitivity for detecting articular fracture reduction in terms of gap displacement and step deformity or offset. Three observers independently reviewed the plain radiographs and CT scans at 2 separate time points and categorised the outcome as either anatomical or non-anatomical. The inter-observer reliability and intra-observer reproducibility of these measurements was expressed as a kappa statistic. The radiological result was correlated with the clinical outcome measures using the Merle D'Aubigne scale, the Harris Hip Score, and the SF-36 score.

Results.

Plain radiography was less effective in the detection of postoperative articular displacement (mean, 75.1% sensitive). The inter-observer and intra-observer agreement between reviewers was good to excellent in detecting reduction quality between the 2 modalities. Patient management was not altered by the findings of the CT scans.

Conclusions.

Although postoperative CT scanning of acetabular fractures in selective cases may be useful, issues such as higher cost, less effective allocation of resources, and excessive radiation doses do not support its routine use.
Closed Reduction for Traumatic Posterior Dislocation of the Shoulder Using the ‘Lever Principle’: Two Case Reports and a Review of the Literature
Authors: Mimura T , Mori K , Matsusue Y , Tanaka N , Nishi Y , Kobayashi M
Published: October 2016

Traumatic posterior dislocation of the shoulder is frequently missed because of its rarity and the absence of characteristic symptoms. Several signs should be emphasised: an overlap of the humeral head and glenoid rim in a true anteroposterior view and the light-bulb sign in the anteroposterior view. To make an accurate and early diagnosis, use of multidirectional radiographs combined with computed tomography is recommended. Closed reduction was successfully performed under general anaesthesia using the DePalma method with slight modification—the lever principle—by pushing the medial side of the upper arm laterally to adduct the shoulder as far as possible. The dynamics of the lever principle make it a safer and more effective method of achieving a closed reduction of a posterior dislocation of the shoulder than the conventional method of solely pushing the humeral head anteriorly, especially in patients with locking of the glenohumeral joint and impression fractures.
Proximal Femoral Focal Deficiency as a Manifestation of Antley-Bixler Syndrome: A Case Report
Authors: Sulaiman AR , Nawaz H , Munajat I , Sallehudin AY
Published: October 2016

We report a case of the Antley-Bixler syndrome in an 11-year-old girl. She presented with bilateral proximal femoral focal deficiency, right clubfoot, left radiohumeral synostosis, bilateral ear hypoplasia, cleft palate, tongue tie, missing teeth, congenital heart disease, a pelvic kidney with hydronephrosis, and mental retardation. Proximal femoral focal deficiency has never been reported before as a manifestation of Antley-Bixler syndrome. Her mother was exposed to radiation during an intravenous urogram done in the first trimester of pregnancy. Exposure to radiation has not been implicated as a cause of Antley-Bixler syndrome.
Omnifit Acetabular Component: A Solution to Preventing and Treating Dislocation
Authors: Jones SA , John A , Mahesen M , Blom AW , Wharton R , Bannister GC
Published: October 2016

Purpose.

To assess short- to medium-term outcome of the Omnifit constrained acetabular component in preventing dislocation in at-risk patients after total hip arthroplasty (THA).

Methods.

81 patients (mean age, 77 years) underwent either primary or revision THA with an Omnifit constrained acetabular component and were followed up clinically and radiologically for a mean period of 24 months.

Results.

There was one dislocation and one revision for avulsion of the acetabulum. The remaining prostheses remained well fixed.

Conclusions.

In the short- to medium-term, the Omnifit constrained acetabular component is effective in preventing primary and recurrent dislocation in at-risk patients. Long-term follow-up is needed to assess whether good fixation is maintained. The Omnifit acetabular cup is recommended for elderly patients with limited life expectancy and functional demands.
Right Hip Adduction Deficit and Adolescent Idiopathic Scoliosis
Authors: Cheung KMC , Cheng ACS , Cheung WY , Chooi YS , Wong YW , Luk KDK
Published: October 2016

Purpose.

To determine whether right hip adduction deficit is associated with adolescent idiopathic scoliosis.

Methods.

102 adolescents (mean age, 14 years) with idiopathic scoliosis were prospectively studied. Their spinal curve pattern (according to Lenke's classification), curve severity (by Cobb's angle), and hip adduction ranges of both sides were recorded. Additional factors that may affect hip adduction range including the preferred leg during standing, the presence of hip flexor tightness, and the side of the dominant leg were also assessed.

Results.

The mean Cobb's angle was 27°. The difference in hip adduction range between the right and left hips was 5° (p<0.05). Of 102 patients, 64 had an adduction range deficit of the right hip, 4 of the left hip, and 34 had no difference. Patients with >10° of right hip adduction deficit were associated with a higher proportion of left leg dominance than those with ≤10° of right hip adduction deficit (18% vs 4%).

Conclusion.

Left leg dominance may play a role in right hip adduction deficit and scoliosis.
Acute Plastic Bowing of the Forearm in Adults: A Report of Two Cases
Authors: Tada K , Ikeda K , Tsubouchi H , Tomita K
Published: October 2016

We report 2 adult cases where the diagnosis of acute plastic bowing of the forearm was either delayed or missed. In a 21-year-old man, ulnar bowing was missed and fixation was not performed because the patient had no limitation to his range of movement or pain. In a 24-year-old woman, the presentation of bowing in both the ulna and radius was delayed and corrective osteotomy was necessary for restoration of full range of movement. Prompt diagnosis enables manual reposition for easy restoration of full range of movement.
Modified Rush Pin Technique for Two- or Three-Part Proximal Humeral Fractures
Authors: Mallick A , Hearth M , Singh S , Pandey R
Published: October 2016

Purpose.

To report the outcomes of modified Rush pin fixation for proximal humeral fractures.

Methods.

42 men and 20 women aged 19 to 94 (mean, 64) years with 2- or 3-part proximal humeral fractures underwent reduction and fixation using the modified Rush pin technique. 11 patients died from reasons unrelated to the surgery.

Results.

Of 40 (out of 51) patients completing a subjective functional assessment using an Oxford Shoulder Questionnaire, 28 (70%) had 2-part and 10 (25%) had 3-part displaced fractures, and the remaining 2 (5%) had fracture-dislocations (one being 2-part and one 3-part). 25 (63%) patients were very satisfied (including one with a 3-part fracture after 6 months of rehabilitation), 7 (17%) were moderately satisfied, and 8 (20%) were not satisfied. There were 8 complications, including pin cut-out from the proximal fragment (n=2), proximal pin migration (n=2), distal pin migration (n=1), cortical perforation during surgery (n=1), mild ulnar nerve symptoms (n=1). No patients had non-union, myositis ossificans, avascular necrosis of the humeral head, or axillary nerve injury.

Conclusion.

The modified Rush pin fixation minimises tissue dissection; the implants are cheap and readily available; and the technical expertise is easily learnt. This technique is a suitable alternative of fixing proximal humeral fractures, especially in the elderly.
Locked Intramedullary Nailing versus Dynamic Compression Plating for Humeral Shaft Fractures
Authors: Putti Amit B , Uppin Rajendra B , Putti Babu B
Published: October 2016

Purpose.

To compare functional outcomes, union and complication rates in patients treated with locked intramedullary nailing or dynamic compression plating for humeral shaft fractures.

Methods.

32 men and 2 women with humeral shaft fractures were randomised to undergo locked antegrade intramedullary nailing (IMN, n=16) or dynamic compression plating (DCP, n=18). Patients with pathological fractures, grade-III open fractures, neurovascular injury, or fractures for more than 2 weeks were excluded. Fractures were classified according to the AO classification system (one in A1, 6 in A2, 12 in A3, 6 in B1, and 9 in B2). 28 were injured in road traffic accidents. The functional outcome (according to the American Shoulder and Elbow Surgeons [ASES] score) and rates of union and complication of the 2 groups were compared.

Results.

All patients were followed up for a minimum of 24 months. In the respective IMN and DCP groups, the mean ASES scores were 45.2 and 45.1 (p=0.69), the complication rates were 50% and 17% (p=0.038), and the non-union rates were 0% and 6% (p=0.15). In the IMN group, 2 sustained iatrogenic fractures during nail insertion; 2 had transient radial nerve palsies; one underwent nail removal for shoulder impingement; and 3 had adhesive capsulitis. In the DCP group, one underwent re-operation for implant failure; one had a superficial infection; and one developed adhesive capsulitis.

Conclusion.

The complication rate was higher in the IMN group, whereas functional outcomes were good with both modalities.
Correlation of Low Back Pain to a High-Intensity Zone of the Lumbar Disc in Indian Patients
Authors: Pande Ketan C , Khurjekar Ketan , Kanikdaley Vilas
Published: October 2016

Purpose.

To assess the correlation between low back pain and a high-intensity zone (HIZ) of the lumbar disc in Indian patients.

Methods.

200 patients with low back and/or leg pain underwent magnetic resonance imaging of the lumbosacral spine. The location and severity of pain and disability were assessed using the pain drawing, visual analogue scale, and Oswestry Disability Index, respectively. The inter-observer reliability was assessed using the kappa statistic.

Results.

The prevalence of an HIZ was 13% and 17% according to observers A and B, respectively. The inter-observer reliability was fair (κ=0.64, p<0.005). The presence of an HIZ did not correlate with low back pain according to the pain drawing, visual analogue scale, and Oswestry Disability Index. According to the pain drawing data, the sensitivity, specificity, and positive predictive values of an HIZ to low back pain were 11%, 82%, and 62%, respectively.

Conclusion.

The presence of an HIZ is not diagnostic of a disrupted and painful disc, and should be interpreted together with other prevailing symptoms and clinical findings.
Conversion of Hip Arthrodesis to Hip Resurfacing: A Case Report
Authors: Sinha Satyajit , Ihedioha Ugo , Shareef Sajan , Campbell Alexander
Published: October 2016

Patients with hip arthrodeses are at risk of developing back pain or pain in other joints in the long term. Conversion to a total hip replacement or hip resurfacing leads to resolution of symptoms in most patients. We report a 40-year-old man who underwent conversion of a hip arthrodesis to hip resurfacing with good results.
Perioperative Management for Orthopaedic Patients with Sickle Cell Anaemia
Authors: Marulanda German A , Minniti Caterina P , Ulrich Slif D , Seyler Thorsten M , Mont Michael A
Published: October 2016

Purpose.

To compare outcomes of 2 types of perioperative optimisation for patients with sickle cell anaemia (SCA) undergoing various orthopaedic surgeries.

Methods.

12 female and 11 male patients aged 13 to 40 (mean, 18) years with SCA underwent 31 separate orthopaedic procedures for osteonecrosis of the femoral head. They were referred to a haematologist for 2 types of perioperative optimisation, based on the choice of the attending paediatrician. In the aggressive management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to 9 to 11 g/dl and to lower the haemoglobin S level to <30%. Fresh frozen plasma was given when their Factor VII level was <30%. In the conservative management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to a minimum of 10 g/dl. Fresh frozen plasma or packed red blood cells were given intra-operatively only when excessive bleeding occurred. The length of hospital stay, the number of perioperative complications, the number of transfusions, and episodes of alloimmunisation and/or vaso-occlusive crises in the two groups were compared.

Results.

No patient in the aggressive management group received supplemental oxygen or had an estimated intra-operative blood loss of >400 ml. Three patients in the conservative management group received multiple intra- and post-operative transfusions and supplemental oxygen.

Conclusion.

Both aggressive and conservative protocols may be safely used in SCA patients. The more aggressive protocol resulted in lower rates for postoperative complications, transfusions, and resorting to supplemental oxygen.
Differential Distraction for Relapsed Clubfoot Deformity in Children
Authors: Devadoss A , Devadoss Sathish , Kapoor Amit
Published: October 2016

Purpose.

To evaluate the long-term outcome of clubfoot correction following differential distraction using the Joshi external stabilisation system (JESS).

Methods.

13 male and 9 female patients aged 1.5 to 5 years with 28 idiopathic clubfeet underwent differential distraction using JESS for relapsed deformity after posteromedial soft-tissue release. They were available for review after a mean of 12 years. Deformities of the feet were rigid and graded as Dimeglio type III or more. Pain, function, and satisfaction were evaluated using a questionnaire. Alignments of the forefoot and hindfoot, subtalar motion, ankle range of movement, muscle power, foot size, calf circumference, and limb length discrepancy were also evaluated. Each foot was rated using the Ponseti scale.

Results.

In 16 patients with unilateral clubfoot, the abnormal side differed significantly from the normal side in terms of foot size, calf circumference, ankle motion, and Ponseti score. Most affected feet were smaller. The mean Ponseti score for the 28 clubfeet was 80. 20 of the feet had good-to-excellent and 5 had fair scores, whereas 3 had poor scores (because of recurrence of deformity). Most patients were able to perform activities of daily living without any problem. The function of the ankle and subtalar joints was limited. Only 3 feet achieved ankle dorsiflexion of >10°, 15 were beyond neutral to 10°, 7 were neutral, and 3 were less than neutral. Most patients developed pin site infection, but none necessitated premature removal of the assembly or any surgical intervention.

Conclusion.

Differential distraction using JESS enabled long-term maintenance of correction and good function, despite hindfoot stiffness.
Arthroscopic Resection of a Bucket Handle Tear of the Meniscus: A Technical Note
Authors: Nakase Junsuke , Kitaoka Katsuhiko , Tsuchiya Hiroyuki
Published: October 2016

Arthroscopic resection of bucket handle tears of the meniscus is difficult owing to the obstructed view of the posterior horn. It often requires an additional portal for access or additional tools. We describe a technique involving conventional tools including grasper, shaver, and basket forceps. No additional portal is required. The basket forceps are used to cut the anterior attachment of the tear, and the bucket handle is shaved to a suitable size. The grasper is then used to hold the remaining meniscus and move it to the posterior space. The posterior corner of the meniscus is then turned over so that its posterior horn can be seen and accessible for cutting. This technique is primarily for medial meniscectomy. For lateral meniscectomy, the conventional technique may suffice, as the lateral compartment can be easily expanded between the femur and tibia.
Effect of Medial Soft-Tissue Releases during Posterior-Stabilised Total Knee Arthroplasty
Authors: Chen Weijia , Nagamine Ryuji , Kondo Keiichi , Todo Mitsugu
Published: October 2016

Purpose.

To assess the effect of each step of medial soft-tissue releases on the joint gap angle during posterior-stabilised total knee arthroplasty (TKA).

Methods.

82 women and 9 men (mean age, 72 years) with medial osteoarthritic knees underwent 100 posterior-stabilised TKAs, in which release of superficial fibres of the medial collateral ligament (MCL) were required using the gap control technique. The order of releases was the superficial MCL, the pes anserinus, and then the semi-membranosus. The superficial MCL was released selectively. The effect of each step of medial soft-tissue releases in full extension and in 90° flexion was compared.

Results.

After all medial soft-tissue releases, the mean joint gap angles decreased from 8.7° to 3.8° varus in flexion and from 4.4° to 1.4° varus in extension. The total effect of medial soft-tissue releases was significantly larger in flexion than in extension (4.9°±3.2° vs. 3.0°±2.0°, p<0.0001), except for the release of posterior fibres of the superficial MCL. The effect of release of the semi-membranosus in flexion was largest.

Conclusion.

The release effect was significantly greater in flexion than in extension during posterior-stabilised TKA; the joint gap technique may be more reliable in medial osteoarthritic knees with moderate and severe varus instability.
Consent Process for Elective Total Hip and Knee Arthroplasty
Authors: Beresford-Cleary Nicolas , Halliday Jane , Biant Leela , Breusch Steffen
Published: October 2016

Purpose.

To assess the consent process for elective primary total hip replacement (THR) and total knee replacement (TKR) in our hospital.

Methods.

Consent processes of 47 THR and 53 TKR patients performed by 11 surgeons were reviewed. Complications that were documented were recorded, as was the grade of surgeon (consultant or specialist trainee) performing consent, and the location at which this took place. Comparisons were made between rates of documented, clinically significant complications discussed during consent, and those listed in the British Orthopaedic Association (BOA), in the literature, and other joint registries.

Results.

The consent processes of 37, 57, and 6 patients were conducted by consultants, specialist trainees, and both, respectively. 13% and 21% of THR patients had ‘revision’ and ‘heterotropic ossification’, respectively, documented as complications, neither of which were listed on the BOA consent form. Similarly 4% and 11% of TKR patients had ‘revision’ and ‘dissatisfaction’, respectively, documented as complications, neither of which were listed on the BOA consent form. In 23% of THR and 32% of TKR patients, none of the BOA-listed complications was documented. In 13% of THR and 15% of TKR patients, no complications were documented. In 13% of THR and 17% of TKR patients, only non-specific descriptions of complications (e.g. morbidity, mortality and medical complications) were used in their consent forms.

Conclusion.

Documentation of complications for THR and TKR patients was often incomplete and variable. The use of structured, procedure-specific consent forms is recommended.
Predictors of Neck Pain after Motor Vehicle Collisions: A Prospective Survey
Authors: Harris Ian A , Young Jane M , Jalaludin Bin B , Solomon Michael J
Published: October 2016

Purpose.

To identify possible predictors (psychosocial) of neck pain in patients with acute injuries following motor vehicle trauma.

Methods.

221 male and 85 female patients aged 18 to 85 (mean, 38) years who had acute fractures of the humerus, radius, ulna, pelvis, femur, patella, tibia, talus or calcaneus following motor vehicle trauma were prospectively recruited. No patient sustained a cervical spine injury. Patients sustaining minor trauma were excluded. As putative predictors of neck pain, data relating to demographics, injury, socio-economic status, and compensation were collected at the time of presentation and at month 6. Neck pain was measured by adapting the bodily pain questions from the SF-36 general health survey. Simple unadjusted and multiple regression analyses were conducted.

Results.

232 (76%) of the 306 patients completed the 6-month questionnaire. In multiple regression analysis, neck pain at 6 months was significantly associated with female gender, having a primary level of education only, and use of a lawyer.

Conclusion.

Adversarial legal and compensation involvement may attribute to the development and continuation of neck pain after motor vehicle trauma.
Ossification of the Posterior Atlantoaxial Membrane Associated with an Os Odontoideum: A Case Report
Authors: Ohya Junichi , Chikuda Hirotaka , Sugita Shurei , Ono Takashi , Oshima Yasushi , Takeshita Katsushi , Kawaguchi Hiroshi , Nakamura Kozo
Published: October 2016

We report a case of ossification of the posterior atlantoaxial membrane associated with an os odontoideum in a 46-year-old woman. She developed myelopathy following a minor motor vehicle accident. The patient underwent posterior atlantoaxial arthrodesis and resection of the ossified lesion and recovered uneventfully. Long-standing atlantoaxial instability might have played a role in ectopic ossification of the posterior atlantoaxial membrane.
Hyaluronic Acid Instillation following Arthroscopic Anterior Cruciate Ligament Reconstruction: A Double-Blinded, Randomised Controlled Study
Authors: Chau Jackie YM , Chan WL , Woo SB , Cheng SC , Wong TM , Wong TK , Yen CH , Wong K , Wong WC
Published: October 2016

Purpose.

To assess the effect of hyaluronic acid instillation after arthroscopic anterior cruciate ligament (ACL) reconstruction for improving pain, range of movement, and function of the knee.

Methods.

28 men and 4 women underwent arthroscopic ACL reconstruction for isolated ACL rupture (partial or complete) and instability after recreational sports injury 2 to 120 months earlier. They were randomised to undergo arthroscopic ACL reconstruction followed by intra-articular viscoseal instillation (13 men and 3 women) or arthroscopic ACL reconstruction alone (15 men and 1 woman). The knee injury osteoarthritis outcome score (for pain, symptoms, activities of daily living, sport and recreation function, and quality of life), range of movement, knee circumference, and analgesic use were assessed on days −1, 1, and 2, and weeks 2, 6 and 12.

Results.

Patient demographics were similar at baseline. At postoperative days 1 and 2, all subscales of the knee injury osteoarthritis outcome score (except for quality of life) were significantly higher in the viscoseal group. At weeks 2, 6, and 12, improvement in both groups equalised. Knee swelling (change in knee circumference) was significantly less in the viscoseal group at days 1 and 2 (p=0.009 and p=0.038, respectively, Mann-Whitney U test). Only one patient in the viscoseal group had a limited range of movement. No patient developed any adverse reaction.

Conclusion.

Intra-articular viscoseal instillation improved pain control and swelling 2 days after arthroscopic ACL reconstruction.
Venous Thromboembolism in Japanese Patients with Fractures of the Pelvis and/or Lower Extremities Using Physical Prophylaxis Alone
Authors: Niikura Takahiro , Lee Sang Yang , Oe Keisuke , Koh Akihiro , Koga Takaaki , Dogaki Yoshihiro , Okumachi Etsuko , Kurosaka Masahiro
Published: October 2016

Purpose.

To investigate the rate of venous thromboembolism (VTE) in Japanese patients with fractures of the pelvis and/or lower extremities using physical prophylaxis alone.

Methods.

Records of 66 men and 60 women aged 15 to 95 (mean, 57) years with fractures of the pelvis and/or lower extremities were retrospectively reviewed. They were screened for VTE based on D-dimer values. Contrast-enhanced computed tomography and/or ultrasonography were performed when the D-dimer value did not decline predictably or exceeded 20 μg/ml even 5 days after injury or surgery. Physical prophylaxis for VTE in terms of graduated compression stockings and intermittent pneumatic compression were applied for all patients.

Results.

Of the 126 patients, 24 were detected to have VTE (10 of 29 with multiple fractures and 14 of 97 with single fractures). Six patients were detected to have asymptomatic pulmonary thromboembolism (PTE), whereas 20 patients were detected to have deep vein thrombosis (bilaterally in 7). The rates of VTE were high in patients with multiple fractures (35%), pelvic fractures (18%), and femoral shaft fractures (50%). The rate of PTE was high in patients with pelvic fractures (12%).

Conclusion.

The rate of VTE in the Japanese patients was similar to that in western populations. Our screening method was useful for preventing fatal PTEs. Surgeons should be vigilant for VTE during the first 2 weeks after injury, especially in patients with multiple and pelvic fractures.
Triplane Fractures of the Distal Tibia in Children
Authors: Tan Adrian Chong Beng , Chong Roland Weng Wah , Mahadev Arjandas
Published: October 2016

Purpose.

To review 28 cases of paediatric triplane fractures of the distal tibia over a 7-year period in a tertiary paediatric hospital.

Methods.

Records of 21 boys and 7 girls aged 11 to 15 (mean, 13) years presented with triplane fractures of the left (n=14) and right (n=14) ankles were retrospectively reviewed.

Results.

Injury mechanism included low-energy trauma (n=10) and moderate-energy trauma (n=18). Fractures were 2-part in 20 patients, 3-part in 6, and 4-part in 2. 11 patients had concomitant fibular fractures. Articular displacement was <2 mm in 17 patients and ≥2 mm in 11 patients. 17 patients were treated conservatively (cast immobilisation); 11 were treated surgically by closed reduction and percutaneous pinning (n=1), open reduction and percutaneous pinning (n=5), closed reduction and internal fixation (n=3), or open reduction and internal fixation (n=2). Transepiphyseal partially threaded cannulated screws were used for fixation. The mean period of casting was 5.8 weeks, and the mean non–weight bearing period was 6.1 weeks. The mean follow-up period was 14.2 (range, 9–20) weeks. All patients had excellent outcome. No patient had any infections, delayed or non-union. Six patients had decreased range of motion and 4 had pain 4 weeks after cast removal.

Conclusion.

Treatment outcome of triplane fractures of the distal tibia in children is good when guidelines are closely adhered to.
Synovial Osteochondromatosis of the Hip with Femoroacetabular Impingement and Osteoarthritis: A Case Report
Authors: Fukui Kiyokazu , Kaneuji Ayumi , Amaya Shinjiro , Matsumoto Tadami
Published: October 2016

Synovial osteochondromatosis is a rare, benign condition characterised by synovial metaplasia and the formation of cartilaginous and osteocartilaginous bodies in the capsule. We report one such case in a 30-year-old woman with synovial osteochondromatosis of the hip and progressive osteoarthritis caused by femoroacetabular impingement with joint-space narrowing. She underwent surgical removal of 32 loose bodies and osteochondroplasty. A coronal osteophyte at the junction of the femoral head and neck was also excised. At 2-year follow-up, her Harris Hip Score had improved from 62 to 90.