bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior Deltopectoral Approach for Axillary Nerve Neurotisation
Authors: Jerome J Terrence Jose
Published: October 2016

Purpose.

To report outcome of axillary nerve neurotisation for brachial plexus injury through the anterior deltopectoral approach.

Methods.

Nine men aged 20 to 52 (mean, 27.8) years with brachial plexus injury underwent axillary nerve neurotisation through the anterior deltopectoral approach. Three of the patients had complete avulsion of C5-T1 nerve roots. The remaining 6 patients had brachial plexus injury of C5-C6 nerve roots, with associated subluxation of the glenohumeral joint, atrophy of the supraspinatus, deltoid and elbow flexors. They had no active shoulder abduction, external rotation, and elbow flexion. The pectoralis major and minor were cut and/or retracted to expose the underlying infraclavicular plexus. The axillary nerve was identified with respect to the available donor nerves (long head of triceps branch, thoracodorsal nerve, and medial pectoral nerve). In addition to the axillary nerve neurotisation, each patient had a spinal accessory nerve transferred to the suprascapular nerve for better shoulder animation.

Results.

Patients were followed up for 24 to 30 (mean, 26) months. In the 3 patients with C5-T1 nerve root injuries, the mean active abduction and external rotation were 63° and 20°, respectively, whereas the mean abduction strength was M3 (motion against gravity). In the 6 patients with C5-C6 nerve root injuries, the mean active abduction and external rotation were 133° and 65°, respectively, whereas the strength of the deltoids and triceps was M5 (normal) in all. In 4 patients with the pectoralis major cut and repaired, the muscle regained normal strength.

Conclusion.

The anterior deltopectoral approach enabled easy access to all available donor nerves for axillary nerve neurotisation and achieved good outcomes.
Infection Risk from Surgeons' Eyeglasses
Authors: Butt Umer , Saleem Urfan , Yousuf Kamran , El-Bouni Tarek , Chambler Andrew , Eid Ahmed Shawky
Published: October 2016

Purpose.

To assess bacterial contamination of 20 eyeglasses from surgeons.

Methods.

40 samples were taken from the nose pad (n=20) and earpiece (n=20) of 20 eyeglasses from orthopaedic surgeons using a sterile swab stick soaked in sterile distilled water. Swabs were incubated and inoculated onto 3 plates: Staphylococcus/Streptococcus agar plate, Mannitol salt plate, and Chromogenic agar plate. Organisms isolated were identified.

Results.

Of 20 eyeglasses, 19 were contaminated with Staphylococcus epidermidis (3 of them additionally grew S haemolyticus or S xylosus) and the remaining one grew S aureus.

Conclusion.

Eyeglasses are a source of surgical infection. Contamination can be caused by direct contact of the eyeglasses to the wound and indirect contact by the surgeon's fingers, splashes from saline irrigation, and through air. Therefore, disinfection should be performed for eyeglasses of surgeons. The use of surgical visor masks or filtered exhaust helmets (space suits) are alternatives.
Pedicle Freezing with Liquid Nitrogen for Malignant Bone Tumour in the Radius: A New Technique of Osteotomy of the Ulna
Authors: Torigoe Tomoaki , Tomita Yoshimasa , Iwase Yoshiyuki , Aritomi Kentaro , Suehara Yoshiyuki , Oukubo Taketo , Sakurai Akira , Terakado Atsuhiko , Tatsuya Tatsuya , Kaneko Kazuo , Saito Tsuyoshi , Yazawa Yasuo
Published: October 2016

We describe a new technique of pedicle freezing of the distal radius with malignant bone tumour and osteotomy of the normal ulna. The distal radius was sufficiently elevated to enable freezing without damaging adjacent tissues by releasing the distal radio-ulnar and radio-carpal joint and cutting the middle third of the ulna. The distal radius (including the tumour) was soaked in liquid nitrogen and the defect filled with iliac grafts. The ulna was repaired with plate and screws and was united at month 2. There was no local recurrence and the postoperative function score was 93%. This technique decreases the risk of non-union of the osteotomy site of the tumorous bone.
Medium-Term Results of Oxford Phase-3 Medial Unicompartmental Knee Arthroplasty
Authors: Clement Nicholas David , Duckworth Andrew David , MacKenzie Sam Peter , Nie Yuan Xin , Tiemessen Christopher Henricus
Published: October 2016

Purpose.

To review medium-term results of 49 consecutive patients who underwent Oxford phase-3 medial unicompartmental knee arthroplasty by a single surgeon.

Methods.

Records of 28 women (mean age, 71 years) and 21 men (mean age, 68 years) who underwent minimally invasive Oxford phase-3 medial unicompartmental knee arthroplasty by a single surgeon were retrospectively reviewed. The Oxford knee score and visual analogue scale (VAS) scores for pain and satisfaction were assessed at the latest follow-up by an independent observer, as were postoperative radiographs for implant position, osteoarthritic changes in the non-replaced compartments, and radiolucent lines of >2 mm or implant subsidence. The survival rate was calculated using Kaplan-Meier survival analysis. Patient demographics, postoperative alignment (varus/valgus), Oxford knee scores, and the progression of osteoarthritis in the other compartments were included in a multiple logistic regression (MLR) analysis to identify significant factors affecting the probability of being satisfied (VAS scores for satisfaction of ≤2).

Results.

The mean follow-up duration was 7.2 years. No patient was lost to follow-up. Two patients with no knee symptoms died (unrelated to surgery) before the 5-year follow-up. The cumulative survival rate at the 9-year follow-up was 91.2% (95% confidence interval, 87.6–94.5%). There were 4 early failures (before 4 years). One patient early in the series developed avascular necrosis of the lateral femoral condyle with an over-corrected tibiofemoral valgus of 12° at 8 months; the other 3 complained of anterior knee pain, without signs of osteoarthritis. All 4 patients underwent revision with total knee arthroplasty. There were 43 patients with more than 5 years of follow-up and without revision of the prosthesis. Patients who were not satisfied (n=6) were more likely to be <65 years old (n=4, adjusted odds ratio [OR], 3.1; MLR p=0.002) and male (n=4; adjusted OR, 2.3; MLR p=0.02). Six of the 43 patients had lucent lines on radiographs, all of which were partial and under the tibial component. Progression of the arthritis in the patellofemoral and/or lateral compartments was worse in 5 patients.

Conclusion.

Careful patient selection and good surgical technique contributed to good outcome. Younger male patients should be counselled regarding the higher chance of limited satisfaction.
Screw and Wire Fixation for Lisfranc Fracture Dislocations
Authors: Ghate Sushant D , Sistla Vidyasagar M , Nemade Vijay , Vibhute Dinesh , Shahane Sunil M , Samant Ashwin D
Published: October 2016

Purpose.

To assess mid-term outcome of screw and wire fixation for Lisfranc fracture dislocations to determine the risk factors of post-traumatic arthritis.

Methods.

15 men and 4 women aged 21 to 58 (mean, 41) years with Lisfranc fractures underwent open/closed reduction and internal fixation (using screw and wire). Fractures were classified as homolateral (n=7), isolated (n=7), and divergent (n=5). Six patients had open fractures; 8 patients injured 5 tarsometatarsal joints; and 6 patients had pure ligamentous injury. Outcome (pain, function, and cosmesis) was assessed using the Maryland foot score and the American Orthopedic Foot and Ankle Society (AOFAS) score. Weight-bearing radiographs were evaluated for non-union, subluxation, malalignment, and post-traumatic arthritis.

Results.

Patients were followed up for 24 to 40 (mean, 30) months. Patients with anatomic reduction (n=14) achieved higher mean AOFAS foot score (79.3 vs. 67.5, p=0.0007) and Maryland foot score (80.4 vs. 69.4, p=0.0009) than did patients with non-anatomic reduction (n=5). Post-traumatic arthritis occurred significantly more often in patients with non-anatomic than anatomic reduction (3/5 vs. 1/14, p=0.037). Four patients developed post-traumatic arthritis, one of whom also developed lateral subluxation after implant removal. Two patients developed fat foot. Two patients had severe symptoms that limited function, one of whom underwent an arthrodesis. Two patients with compound fractures developed superficial infections. Three patients had broken screws.

Conclusion.

Anatomic reduction is the main predictor of outcome in patients with Lisfranc fracture dislocations.
Conservative Treatment for Juvenile Osteochondritis Dissecans of the Talus
Authors: Lam Kai Yet , Siow Hua Ming
Published: October 2016

Purpose.

To assess outcome of 6 juvenile patients with osteochondritis dissecans (OCD) of the ankle treated conservatively.

Methods.

Records of 4 males and one female aged 10.8 to 14.1 (mean, 12.3) years who underwent cast immobilisation and/or restriction of physical activities for OCD of the talus (4 on the left and 2 on the right) were reviewed. OCD lesions were graded using the Berndt and Harty classification. Functional outcome was assessed using the ankle-hindfoot score of the American Orthopaedic Foot and Ankle Society. Clinical and radiographic outcomes were assessed according to the Higuera classification.

Results.

The mean follow-up period was 30.5 (range, 11–63) months. The mean ankle-hindfoot score was 90 (range, 86–100). Radiological resolution of OCD was noted in 2 ankles, although all ankles showed some degree of healing. All patients had resolution of pain after a mean of 7 (range, 3–12) months. According to the Higuera classification, clinical outcome was excellent in one and good in 5 ankles, whereas radiological outcome was excellent in 2, good in 2, and fair in 2 ankles. In one patient, the OCD of the right posteromedial talar dome resolved spontaneously.

Conclusion.

Almost all patients achieved good functional outcome after conservative management, regardless of the presence of radiological evidence of healing. Surgery should only be performed if the OCD is unstable.
Distraction Osteogenesis Using a Monolateral External Fixator for Infected Non-Union of the Femur with Bone Loss
Authors: Arora Sumit , Batra Sumit , Gupta Vikas , Goyal Aman
Published: October 2016

Purpose.

To review records of 15 patients who underwent distraction osteogenesis/bone transport using a monolateral external fixator for infected nonunion of the femoral shaft.

Methods.

13 men and 2 women aged 18 to 47 years underwent adequate debridement and resection of nonviable bone, followed by bone transport using a monolateral external fixator for infected non-union of the femoral shaft with bone loss. All patients had a bone defect of >5 cm. The lengthening index, radiographic consolidation index, functional status, bone healing, and various problems, obstacles and complications encountered during the treatment were assessed.

Results.

The patients had undergone a mean of 2.9 (range, 1–7) surgical procedures before presentation. The mean duration from trauma to presentation was 7.7 (range, 6–18) months. The mean bone defect after adequate resection/debridement was 7.9 (range, 5.5–17) cm. The mean treatment duration was 7.3 (range, 5–15) months. The mean lengthening index was 12.3 (range, 11.5–15) days/cm. The mean treatment index was 27.9 (range, 24–40) days/cm. The mean follow-up duration was 19.3 (range, 15–41) months. Functional outcome was excellent in 5, good in 8, and fair in 2 patients. All patients achieved bone union and eradication of infection. Bone healing was excellent in 12 and good in 3 patients. All the patients were satisfied with the procedure. None had neurovascular complications, joint subluxations, or refracture of the regenerated bone. True complications encountered included knee stiffness (n=6) and knee flexion contracture (n=1). Three patients with an initial bone defect of >10 cm had delayed union and underwent bone grafting.

Conclusion.

Bone transport using a monolateral external fixator is safe and effective for treating infected non-union of the femoral shaft.
Mycobacterium Marinum Infection of the Hand and Wrist
Authors: Cheung Jason Pui Yin , Fung Boris , Ip Wing Yuk , Chow Shew-Ping
Published: October 2016

Purpose.

To review records of 166 patients who underwent treatment for Mycobacterium marinum tenosynovitis of the hand and wrist to identify factors associated with functional outcome.

Methods.

Records of 97 men and 69 women aged 13 to 85 (mean, 50) years who underwent treatment for suspected M marinum tenosynovitis of the hand and wrist were retrospectively reviewed. All underwent open biopsy; synovectomy was performed when florid synovitis was present. Rifampicin and ethambutol were usually prescribed. Clarithromycin, minocycline and/or levofloxacin were used as adjuvants if there was drug intolerance, allergy, or relapse. The duration of antibiotic treatment depended on the clinical recovery. Patients were followed up for one year after completion of drug treatment. Functional outcome was considered excellent for those with >195° total active motion (TAM) and >75% return of motion, good for those with 130° to 195° TAM and 50 to 75% return of motion, fair for those with 65° to 129° TAM and 25 to 49% return of motion, and poor for those with <65° TAM and <25% return of motion.

Results.

The mean delay in presentation was 4.9 (0.3–120) months. 93 of the patients presented with disabilities (fexion deformity or reduced range of motion), 64 of whom presented one month after injury. 37 (22%) of the patients had received intralesional steroids prior to admission, 30 of whom presented one month after injury. 32 (19%) patients were treated with antibiotics alone, whereas 134 (81%) patients underwent debridement in addition to antibiotic treatment. The mean duration of antibiotic treatment was 7.2 (range, 0–29) months. Of the 156 patients who completed the follow-up, functional outcome was satisfactory in 128 (82%) and unsatisfactory in 28 (17%). Steroid injections and late presentation led to worse functional outcome. Patients with unsatisfactory outcome were more likely to have received intralesional steroid injections (43% [16/37] vs. 10% [12/118], p<0.001, Pearson Chi squared test), have presented >2 months after injury (27% [21/79] vs. 9% [7/77], p=0.004, Pearson Chi squared test), and have undergone synovectomy (23% [28/124]) vs. 0% [0/32], p=0.001, Fisher's exact test). Worse functional outcome correlated with late presentation ( r=0.218) and the greater number of debridement procedures ( r=0.453).

Conclusion.

Delayed antibiotic treatment of M marinum infections and steroid injections were associated with unsatisfactory outcome. Clinicians must have a high index of suspicion for this condition and avoid inappropriate management such as intralesional steroid injections. Public awareness to this condition should be raised.
Unicameral Bone Cyst of the Scaphoid: A Report of Two Cases
Authors: Javdan Mohammad , Zarezadeh Abolghasem , Gaulke Raulf , Eshaghi Mohammad Amin , Shemshaki Hamidreza
Published: October 2016

Unicameral bone cysts are benign, fluid-filled lesions that occur mostly in long bones (proximal humerus, 50–60%; femur, 30%) of male children aged 5 to 15 years. Occurrence in the scaphoid of an adult is rare. We report 2 such patients who presented with wrist pain, with and without a history of trauma. Both underwent curettage and bone grafting (harvested from the distal radius) and achieved good functional recovery.
Impaction-Fracture of the Capitate and Lunate: A Case Report
Authors: Ong Joshua Chong Yew , Devitt Brian Meldan , O'Sullivan Micheal Edmund
Published: October 2016

We report a 15-year-old girl who underwent a mid-carpal fusion for undiagnosed impaction-fractures of the capitate, lunate, and triquetrum after a fall on her outstretched left hand in a dorsiflexed and radially deviated position. The joint was dis-impacted, and the height of the lunate was restored using a cortical bone graft. The damaged proximal capitate articular surface was decorticated to facilitate fusion, as was the lunotriquetral articulation. Kirschner wires were inserted along the coronal plane. At the one-year follow-up, the patient had achieved a satisfactory range of motion and fusion of the capitate-lunate-triquetral articulations.
A Glass Foreign Body Migrating into the Lumbar Spinal Canal: A Case Report
Authors: Yoshioka Katsuhito , Kawahara Norio , Murakami Hideki , Demura Satoru , Matsuda Masaki , Tomita Katsuro , Tsuchiya Hiroyuki
Published: October 2016

We report on a 12-year-old boy in whom a glass fragment migrated into the lumbar spinal canal causing low back pain and radiculopathy 6 years after injury. Computed tomography showed a foreign body in the anterior spinal canal of L5/S1. The patient underwent recapping T-saw laminoplasty to remove the foreign body. Scar formation was noted at the anterior dura. The glass fragment seemed to have penetrated into the intradural space from an anterior site. Postoperatively, the pain resolved immediately. At the 9-year follow-up, the alignment of the lumbar spine and healing of L5 was good, with no features of aseptic necrosis.
Portal Vein Thrombosis after Total Knee Replacement: A Case Report
Authors: Martin Guy , Rashid Abbas , Abdul-Jabar Hani B , Jennings Simon
Published: October 2016

We present a 74-year-old woman who developed a portal vein thrombosis following an elective total knee replacement. She had atrial fibrillation for which she was taking warfarin for anticoagulation. Seven days prior to surgery, she was instructed to discontinue warfarin and replace it with prophylactic low-molecular-weight heparin. On postoperative day 1, routine blood tests revealed deranged hepatic synthetic function, despite standard anticoagulation management. Doppler ultrasonography confirmed a portal vein thrombosis. She was treated with therapeutic doses of low-molecular-weight heparin until her international normalised ratio reached therapeutic levels. Her liver function results had normalised 2 weeks later. Portal vein thrombosis is a potentially fatal complication that is reversible if identified and treated early.
Single Screw-Rod Anterior Instrumentation for Thoracolumbar Burst Fractures with Incomplete Neurological Deficit
Authors: Sharma Siddhartha , Singh Dara , Singh Manjeet , Kohli Arvind , Singh Gurjit , Arora Mohit
Published: October 2016

Purpose.

To evaluate the outcome of single screw-rod anterior instrumentation for thoracolumbar burst fractures with incomplete neurological deficit.

Methods.

16 men and 5 women aged 22 to 55 (mean, 34) years underwent single screw-rod anterior instrumentation for thoracolumbar burst fractures with incomplete neurological deficit. The vertebrae involved were T10 (n=2), T11 (n=2), T12 (n=7), L1 (n=8), and L2 (n=2). No patient had disruption of the posterior ligament complex. Postoperatively, a thoracolumbar sacral orthosis was used until solid fusion. Outcome measures included neurological recovery, degree of kyphosis, complications, and pain and functional status of the patients.

Results.

The mean follow-up duration was 36 (range, 13–50) months. All patients recovered neurologically by at least one grade. Of the 21 patients, 6 improved from grade B to grade C (n=4) or grade D (n=2), 13 from grade C to grade D, and 2 from grade D to grade E. The mean degree of kyphosis improved from 23°±5° to 7°±3°. Seven patients had complications including ipsilateral basal atelectasis (n=3), urinary tract infection (n=1), haematuria (n=1), postoperative ileus (n=1), and superficial wound infection (n=1). None had iatrogenic visceral or vascular injury, pseudoarthrosis or hardware-related complications. Only one patient had severe back pain persistently.

Conclusion.

Single screw-rod anterior instrumentation supplemented with an orthosis can be an alternative for double screw-rod anterior instrumentation for thoracolumbar burst fractures in patients with smaller vertebral bodies.
Congenital Insensitivity to Pain and Anhydrosis: A Report of Two Cases
Authors: Karthikeyan Maharajan , Sreenivas Thimmaiah , Menon Jagdish , Patro Dilip Kumar
Published: October 2016

We report on 2 patients with congenital insensitivity to pain and anhydrosis. The first one was a 7-month-old boy who presented with non-traumatic, haematogenous septic dislocation of the right elbow with physeal separation of the distal humerus. The second one was a 3-year-old girl suspected to have Job syndrome with an altered immunological profile.
Complications and Their Risk Factors following Hip Fracture Surgery
Authors: Poh Keng Soon , Lingaraj K
Published: October 2016

Purpose.

To evaluate various postoperative complications and their risk factors in hip fracture patients.

Methods.

207 female and 87 male consecutive patients (mean age, 78.1 years) who underwent surgical (n=242) or conservative (n=52) treatment for closed fractures of the femoral neck (n=157) or peritrochanter (n=137) were prospectively studied. The types of complication and outcome were recorded. The comorbidity status of the patients was categorised based on the American Society of Anesthesiologists (ASA) classification. Complications and their associations with various risk factors and mortality were analysed.

Results.

For all patients, the mean length of hospitalisation was 14.6 days. For the 242 patients who underwent surgical treatment after a mean of 3.6 days, 56.8% of them had at least one complication. Acute urinary retention (39.3%) and urinary tract infection (24.0%) were most common. Patients with ASA grade III or higher had 2.3 fold higher risk of developing complications than those with lower-grade comorbidity, whereas patients with delayed operation (>48 hours after presentation) had 1.8 fold higher risk of developing complications than those without delayed operation. Four patients died in hospital: 2 from myocardial infarction and 2 from upper gastrointestinal bleeding.

Conclusion.

Complications after hip fracture surgery were common. Advanced age, high ASA status, and delay in surgery were associated with higher complication rates. Operations should be performed on medically fit patients as early as possible.
Correlation between Trochlear Dysplasia and Anterior Cruciate Ligament Injury
Authors: Botchu Rajesh , Obaid Haron , Rennie WJ
Published: October 2016

Purpose.

To evaluate the correlation between trochlear dysplasia and anterior cruciate ligament (ACL) injury

Methods.

Magnetic resonance images (MRIs) of 95 knees in 54 males and 36 females aged 4 to 74 (mean, 28) years who had anterior knee pain and suspected ligamentous injury were reviewed. The MRIs were independently reviewed by 2 musculoskeletal radiologists on 2 occasions. According to the Dejour classification, trochlear dysplasia was classified into types A, B, C, and D. Intra-articular injuries/disorders of the patients included patellofemoral osteoarthritis, chondromalacia patella, meniscal tears, and ligamentous injuries. Intra- and inter-observer variability was calculated.

Results.

58 of the knees had trochlear dysplasia, 38 of which were Dejour type A. The intra- and inter-observer variability was good to excellent (Kappa=0.76–1). ACL tear was the most common injury (n=13). No ACL injury occurred in patients without trochlear dysplasia. The odds of having sustained an ACL injury were 8.8 fold greater in Dejour type-A knees than in non–type-A knees (p=0.023).

Conclusion.

Dejour type-A trochlear dysplasia was associated with ACL injuries.
One-Stage Long-Stem Total Knee Arthroplasty for Arthritic Knees with Stress Fractures
Authors: Mittal Amber , Bhosale Pradeep B , Suryawanshi Ashish V , Purohit Shaligram
Published: October 2016

Purpose.

To evaluate the outcome of one-stage long-stem total knee arthroplasty (TKA) for patients with arthritic knees and tibiofemoral stress fractures.

Methods.

Records of 11 men and 18 women aged 47 to 78 (mean, 66) years who underwent fixed-bearing posterior-stabilised TKA for osteoarthritis or rheumatoid arthritis of the knee with tibial (n=31) and femoral (n=3) stress fractures were reviewed. All the tibial fractures involved the proximal half. There were 7 associated fibular stress fractures. Of the 31 knees with tibial stress fractures, 26 and 5 manifested varus and valgus deformity, respectively.

Results.

The mean follow-up period was 51 (range, 24–96) months. The mean tibiofemoral angle improved from 23.2° to 1.9° varus. The mean Knee Society knee score improved from 38.5 (range, 15–63) to 89.6 (range, 80–95) [p<0.05]. The mean Knee Society functional score improved from 25.5 (range, 0–40) to 86.5 (range, 60–100) [p<0.05]. All fractures were united at the last follow-up. No complications were encountered.

Conclusion.

One-stage long-stem TKA restores limb alignment and facilitates fracture healing, with excellent outcome.
Bosworth Fracture-Dislocation of the Ankle: A Case Report
Authors: Yeoh Ching Sing Nicholas , Tan Gek Meng Jeffrey
Published: October 2016

Bosworth fracture-dislocation of the ankle is a rare injury in which the proximal fibular fragment is entrapped behind the tibia. Closed reduction is extremely difficult to achieve. Early open reduction and internal fixation enables a better outcome by minimising soft-tissue damage. We report on a 36-year-old man who underwent open reduction and internal fixation for a Bosworth fracture-dislocation of the ankle complicated by severe soft-tissue swelling and an impending risk of skin necrosis after failed closed reduction.
A Subtrochanteric Femoral Fracture 15 Years after Radiotherapy: A Case Report
Authors: Sivasubramanian Harish , Ee Gerard , Srinivasaiah Manjunatha Ganiga , De Shamal Das
Published: October 2016

Pathological fracture is a rare but serious complication of radiotherapy. We report on a 44-year-old man who presented with a subtrochanteric femoral fracture 15 years after radiotherapy for a soft-tissue sarcoma in the thigh. We discuss its potential causes, a scoring system to identify high-risk patients for prophylactic intramedullary nailing of the femur, and radiographic signs to identify an impending insufficiency fracture.
Review Article: Venous Thromboembolism after Total Joint Replacement
Authors: Leung KH , Chiu KY , Yan CH , Ng FY , Chan PK
Published: October 2016

Venous thromboembolism can occur in up to 84% of cases following total joint replacement. It can result in pain, swelling, chronic post-thrombotic syndrome, and pulmonary embolism. Its prevention is vital to the success of the surgery. To achieve a safe and effective prophylaxis, a combination of mechanical and pharmacologic agents should be used. New generation of thromboprophylactic agents target different factors of the coagulation pathway.
Fibrodysplasia Ossificans Progressiva: A Case Report
Authors: Dhamangaonkar Anoop C , Tawari Akhil A , Goregaonkar Arvind B
Published: October 2016

Fibrodysplasia ossificans progressiva or myositis ossificans is a rare disease characterised by bony deposits or the ossification of soft tissues. It transforms skeletal muscles, tendons, ligaments, fascia, and aponeuroses into heterotopic bony deposits through an endochondral process. This leads to progressive immobility; patients are usually wheelchair-bound by the second decade of life and die of thoracic insufficiency by the fourth decade of life. There is no treatment apart from symptomatic treatment with steroids during flare-ups. Excision of heterotopic ossification is not recommended as it can provoke extensive and painful new growths. It is important to detect the disease early from characteristic signs of great toe abnormalities and heterotopic ossifications to improve quality of life through early physiotherapy.
Scarf Osteotomy with or without Proximal Phalangeal Osteotomy for Severe Hallux Valgus Deformity
Authors: Marudanayagam Ashok , Appan Sadai V
Published: October 2016

Purpose.

To report outcome of Scarf osteotomy with or without proximal phalangeal osteotomy for correction of severe hallux valgus deformity.

Methods.

Records of 48 women and 4 men aged 28 to 68 (mean, 52) years who underwent 57 Scarf osteotomies with or without proximal phalangeal osteotomy for severe hallux valgus by a single surgeon were reviewed. The patients had a hallux valgus angle (HVA) of up to 55°. An additional proximal phalangeal osteotomy was performed in 11 of the patients whose hallux valgus persisted (HVA >10°). The American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, the HVA and intermetatarsal angle (IMA) on radiographs, and the complication rate were assessed.

Results.

The mean follow-up period was 26 (range, 24–36) months. The mean AOFAS hallux score improved from 57.4 (range, 49–64) to 91.6 (range, 75–100). The mean HVA improved from 38.1° (range, 28°–52°) to 12.8° (range, 5°–20°). The mean IMA improved from 17.0° (range, 13°–24°) to 6.8° (range, 3°–10°). One patient developed chronic regional pain syndrome. There were no instances of non-union, delayed union, or malunion of the osteotomy site.

Conclusion.

Scarf osteotomy with or without proximal phalangeal osteotomy is an effective treatment for correcting severe hallux valgus deformity.
Repair of Achilles Tendon Ruptures with Peroneus Brevis Tendon Augmentation
Authors: Singh Amarjeet , Nag Kushal , Roy Shuvendu P , Gupta Ramesh Chandra , Gulati Vaibhav , Agrawal Nikunj
Published: October 2016

Purpose.

To report 22 patients who underwent repair of compound Achilles tendon ruptures with peroneus brevis tendon augmentation.

Methods.

Records of 6 women and 19 men aged 21 to 42 (mean, 28) years who underwent repair of compound Achilles tendon ruptures with peroneus brevis tendon augmentation were reviewed. All the wounds were transverse/oblique, minimally contaminated, and could be closed primarily. Patients were evaluated at months 3, 9, and 12, using the Foot and Ankle Outcome Score (FAOS) questionnaire.

Results.

Of the 22 patients, 3 developed superficial skin complications that healed gradually, and 2 developed a superficial discharging sinus and underwent minor debridement. No patient had a re-rupture of the Achilles tendon. At the one-year follow-up, all patients achieved good functional outcome in terms of the FAOS.

Conclusion.

Repair of Achilles tendon ruptures with peroneus brevis tendon augmentation achieved good functional outcome.
Enhancing Soft-Tissue Reattachment in Proximal Humeral Endoprosthetic Reconstruction
Authors: Ji Tao , Tang Xiaodong , Guo Wei
Published: October 2016

Purpose.

To report on the use of the Ligament Advanced Reinforcement System (LARS) to enhance joint stability and functional outcome in proximal humeral endoprosthesis reconstruction.

Methods.

Two men and 5 women aged 16 to 66 (mean, 28) years underwent wide resection of tumour and endoprosthesis reconstruction of the proximal humerus using the LARS, as the rotator cuff and/or deltoid muscle could be preserved. The preserved muscles were reattached to anatomic positions to regain function. Shoulder range of motion and Musculoskeletal Tumour Society scores were evaluated.

Results.

The mean follow-up was 26 (range, 14–36) months. All the 7 patients were alive without disease. The mean active abduction was 77° (range, 60°–100°), and the mean active flexion was 74° (range, 50°–100°). The mean Musculoskeletal Tumour Society score was 86% (range, 80–93%). One patient had instability of the glenohumeral joint at one year.

Conclusion.

The LARS may enhance soft-tissue reattachment and improve shoulder stability after proximal humeral endoprosthetic reconstruction.
Tuberculosis of the Trochanteric Bursa: A Case Report
Authors: Kim Seong-Tae , Moon Myung-Sang , Yoon Min-Geun , Park Woo-Sung , Heo Jee-Hyun
Published: October 2016

Tuberculous trochanteric bursitis is rare. We report on a 48-year-old man with a huge gravitational abscess in the thigh secondary to tuberculosis of the trochanteric bursa.
Accuracy of Preoperative Templating in Total Hip Arthroplasty
Authors: Riddick Andrew , Smith Adam , Thomas D Phill
Published: October 2016

Purpose.

To assess the accuracy of templating in total hip arthroplasty (THA).

Methods.

Anteroposterior pelvic radiographs of 20 men and 33 women aged 17 to 80 (mean, 60) years who underwent uncemented THA of the right (n=24) and left (n=29) sides using a single prosthesis were reviewed. A 30-mm–diameter scaling ball was placed between the patient's legs for calculating the magnification factor (MF) of the radiographs. The planned THA was templated using computer software. The positioning of the scaling ball was measured. The preoperative MF was calculated as the size of the ball on radiograph divided by the true size of the ball times 100. The true MF was calculated as the size of the cup on radiograph divided by the true size of the cup times 100. The accuracy of the preoperative MF was calculated as the preoperative MF divided by the true MF times 100.

Results.

The cup size and stem size were predicted correctly (within one size error) in 87% and 92% of the patients, respectively; no template size was greater than 3 size errors. The overall mean pre-and post-operative MFs differed significantly (122% vs. 127%, p±0.001), as did the mean postoperative MFs between males and females (126% vs. 128%, p=0.006). Assuming the MF was constant, and the postoperative measurement was the most accurate, the mean accuracy of preoperative MF was 96% (range, 89.6–99.9%), whereas the relative mean height of the scaling ball was 30 (range, 1–90) mm away from the correct height. The accuracy of the preoperative MF did not correlate with body mass index, the scaling ball position, and the accuracy of cup and stem templates.

Conclusion.

If the MF of 127% is constant across different patients, using a MF of 127% is more accurate than using the scaling ball technique.
Informed Consent Documentation for Total Hip and Knee Replacement Using Generic Forms with Blank Spaces
Authors: Mussa Mohamed Altayeb , Sweed Tamer Ahmed , Khan Aazer
Published: October 2016

Purpose.

To analyse informed consent documentation of 100 patients undergoing elective primary total hip replacement (THR) or total knee replacement (TKR) using generic forms with blank spaces.

Methods.

Informed consent documentation of 57 men and 43 women (mean age, 54 years) undergoing elective primary THR (n=50) or TKR (n=50) using generic forms with blank spaces were analysed. The consent forms were explained to the patients mostly on the morning of surgery by a consultant surgeon (n=21), specialist registrar (n=23), or senior house officer (n=56). Data on patient demographics, planned procedure, benefits and risks of surgery, and the grade of the surgeon were collected.

Results.

In the consent forms for THR, the most frequently documented complications included infection (98%), bleeding (96%), deep vein thrombosis (94%), nerve damage (94%), blood vessel damage (94%), and pain (90%). Common complications (2–5% of occurrence) that were less frequently documented included prosthesis wear or loosening (76%), dislocation (68%), and leg length discrepancy (62%). In the consent forms for TKR, the most frequently documented complications included infection (96%), bleeding (92%), deep vein thrombosis (90%), nerve damage (90%), and blood vessel damage (90%). Common risks (2–5% of occurrence) that were less frequently documented included pain (84%), prosthesis wear or loosening (54%), and knee stiffness (40%).

Conclusion.

Documentation of all clinically significant complications was insufficient when generic informed consent forms with blank spaces were used. The use of standardised procedure-specific consent forms is recommended.
Surgeons' Knowledge about the Costs of Orthopaedic Implants
Authors: Rohman Lebur , Hadi Saifullah , Whitwell George
Published: October 2016

Purpose.

To investigate consultant surgeons' knowledge about the costs of implants for various joint surgeries.

Methods.

Questionnaires were distributed to consultant orthopaedic surgeons at 2 hospitals. Respondents were asked to estimate the implant costs of any brand for low-demand and high-demand total hip replacement (THR), total knee replacement (TKR), uni-compartmental knee replacement, arthroscopy shaver blade, total anterior cruciate ligament (ACL) fixation, and meniscal repair. The actual cost of each implant was obtained from the manufacturer.

Results.

16 consultant surgeons completed the questionnaires. The respective mean estimated and actual costs for a low-demand THR implant were £1714 (range, £600–3000) and £1448 (range, £985–2335), with an overestimation of 18.4%. The respective costs for a high-demand THR implant were £2172 (range, £600–6000) and £1737 (range, £1192–2335), with an overestimation of 25%. The respective costs for a TKR implant were £1550 (range, £600–6000) and £1316 (range, £995–1535), with an overestimation of 17.8%. The respective costs for a uni-compartmental knee replacement implant were £1040 (range, £600–2000) and £1296 (range, £698–1470), with an underestimation of 19.7%. The respective costs for an arthroscopy shaver blade were £110 (range, £75–150) and £94 (range, £80–100), with an overestimation of 16.6%. The respective costs for a total ACL fixation implant were £246 (range, £80–500) and £306 (range, £272–335), with an underestimation of 19.4%. The respective costs for a meniscal repair implant were £153 (range, £50–250) and £242 (range, £170–260), with an underestimation of 37%.

Conclusion.

The knowledge among consultant orthopaedic surgeons about implant costs was poor. To reduce implant costs, cooperation between surgeons and hospital managers and measures to increase surgeons' awareness about cost-reduction programmes are needed.
Radial Head and Neck Injuries in Children with Elbow Dislocations: A Report of Three Cases
Authors: bin Mohd Fadil Muhammad Farhan , Mahadev Arjandas , Gera Sumanth Kumar
Published: October 2016

In children, traumatic elbow dislocations usually occur after the epiphysis has closed and with associated radial head and neck fractures and osteochondral fragments. The fragments are also usually interposed in the joint restricting complete congruent joint motion. We report on 3 children with traumatic elbow fracture-dislocation with associated radial head and neck injuries treated with open reduction and stabilisation. All patients achieved good outcomes and returned to pre-injury level of activities.
Oncogenic Osteomalacia Caused by Phosphaturie Mesenchymal Tumours in the Proximal and Shaft of the Tibia: A Case Report
Authors: Pithankuakul Kongkit , Ratanasuwan Tanaporn , Thanakit Voranuch , Sukhantanak Bhasanan , Kiatisevi Piya
Published: October 2016

Oncogenic osteomalacia is caused by a small mesenchymal tumour characterised by phosphaturia, hypophosphatemia, decreased serum vitamin D3 level, and osteomalacia. Phosphaturic mesenchymal tumour of the mixed connective tissue type (PMTMCT) is the commonest subtype and usually involves a single site. We report a case of PMTMCT involving the left proximal and shaft of the tibia in a 42-year-old man.
Hospital Mortality after Arthroplasty Using a Cemented Stem for Displaced Femoral Neck Fractures
Authors: Ginsel Bastiaan L , Taher Ahmad , Ottley Michael C , Jayamaha Sepalika , Pulle Chrys R , Crawford Ross W
Published: October 2016

Purpose.

To review hospital mortality after hemiarthroplasty or total hip arthroplasty (THA) using a cemented stem for displaced femoral neck fractures.

Methods.

Medical records of 284 hips in 70 men and 209 women aged 45 to 106 (mean, 81.3) years who underwent hemiarthroplasty (n=232) or THA (n=52) with a cemented stem using third-generation cementing techniques (including use of a plug, lavage, and cement pressurisation) for displaced femoral neck fractures were retrospectively reviewed. According to the American Society of Anesthesiologists (ASA) grading, 6 patients were classified preoperatively as grade 1, 77 as grade 2, 148 as grade 3, 47 as grade 4, and one as grade 5. Patients were operated on within 48 hours. Patients were rehabilitated in the hospital until discharge. The primary outcome measure was hospital mortality, including the cause of death.

Results.

The mean length of hospital stay was 9.2 (standard deviation, 4.1) days. The hospital mortality was 5.7% (n=16). Of the 16 patients who died, 3 were classified preoperatively as ASA grade 2, 6 as grade 3, and 7 as grade 4. One patient died during the operation. One patient died in the recovery room within 6 hours. Both died from a cardiac arrest and were classified as ASA grade 4. Six patients died within the first 5 days. The causes of death were aspiration pneumonia (n=5), cardiac arrest (n=3), bowel perforation (n=2), multiple organ failure (n=3), type 2 respiratory failure (n=1), heart failure (n=1), and subarachnoid bleeding after a hospital fall (n=1).

Conclusion.

Hemiarthroplasty or THA using a cemented stem resulted in low hospital mortality in our hospital dedicated to the treatment of geriatric hip fractures. Hospital mortality was higher in patients with ASA grade 3 or higher.
Cancellous Screw Fixation for Undisplaced Femoral Neck Fractures in the Elderly
Authors: Manohara Ruben , Liang Shen , Huang Deborah , Krishna Lingaraj
Published: October 2016

Purpose.

To review the outcomes of cancellous screw fixation for undisplaced femoral neck fractures in elderly patients and to identify the risk factors associated with poor outcomes.

Methods.

Medical records of 100 patients aged 61 to 94 (mean, 78) years who underwent internal fixation with cancellous screws for undisplaced femoral neck fractures were reviewed. According to the Garden classification, 85 fractures were type 1 (impacted fractures) and 15 were type 2 (complete, undisplaced fractures). Postoperative mobility and pain were assessed through a telephone survey. Outcome measures included the length of surgery, length of hospital stay, perioperative complications, postoperative pain, pre- and post-operative mobility status, and rates and causes of implant revision and mortality.

Results.

Of the 96 patients followed up for a mean of 39 (range, 25–76) months, 8 underwent revision surgery for avascular necrosis of the femoral head (n=5) or non-union/implant failure (n=3). Of the 68 patients assessed for postoperative pain and mobility, 15 had pain on movement, whereas 55 could ambulate independently with or without walking aids (out of 61 that could do so preoperatively). Overall, 30 patients had a decrease in their mobility status. Patients aged >75 years (compared with those aged ≤75 years) were associated with longer length of hospital stay (12.7 vs. 10.2 days, p=0.047) and higher mortality rate (23% vs. 7%, p=0.044). The length of hospital stay was also associated with presence of ischaemic heart disease/cerebrovascular accident (14.4 vs. 11.04 days, p=0.002). Pain, mobility, and rates of complication and revision were not associated with any of the variables.

Conclusion.

Cancellous screw fixation for undisplaced femoral neck fractures in elderly patients was associated with relatively low complication and revision rates.
Femoral and Tibial Tunnel Positioning on Graft Isometry in Anterior Cruciate Ligament Reconstruction: A Cadaveric Study
Authors: Smith James O , Yasen Sam , Risebury Mike J , Wilson Adrian J
Published: October 2016

Purpose.

To assess distance changes between the femoral and tibial attachment points of 3 different anterior cruciate ligament (ACL) tunnel entry positions throughout the range of knee motion in cadaveric knees.

Methods.

The ACLs of 11 fresh-frozen cadaveric knees (from 6 men and 5 women) were removed using radiofrequency. Three tibial tunnel placements were made using a cannulated awl, and three 2.4-mm pilot tunnels were drilled on the lateral femoral condyle. One end of an inelastic suture was inserted from each of the 3 femoral holes and fixed on the femoral cortex using a suture button in turn, whereas the other end of the suture was passed through the cannulated awl and fixed on each of the 3 tibial placements in turn, with constant tension. Distance changes of the suture throughout the range of knee movement (0°, 90°, and 135° of knee flexion) were measured for each combination of tibial and femoral positions.

Results.

The distance was minimum when the knee was in full extension (p±0.0001). Most of the distance changes occurred during initial flexion (0°–90°). The most isometric position (mean±standard deviation [SD] distance change, 2.78±0.93 mm; p±0.0001) was noted when the suture was at the anteromedial bundle placement in the femur and anterior in the tibia. The least isometric position (mean±SD distance change, 10.37±2.08 mm; p±0.0001) was noted when the suture was at the mid-bundle position in the femur and at the posterolateral bundle insertion in the tibia. The anatomic position resulted in a mean±SD distance change of 7.63±2.01 mm (p±0.0001). The femoral position had a greater influence on distance change than the tibial position.

Conclusion.

None of the ACL graft positions was isometric. Anatomic ACL positioning resulted in comparable anisometry to the native ACL. The minimum distance for all graft positions was noted in full extension, in which position the graft should be fixed during anatomic ACL reconstruction.
Curettage and Reconstruction by the Sandwich Technique for Giant Cell Tumours around the Knee
Authors: Saibaba Balaji , Chouhan Devendra Kumar , Kumar Vishal , Dhillon Mandeep Singh , Rajoli Sreekanth Reddy
Published: October 2016

Purpose.

To evaluate outcomes of 36 patients who underwent curettage, use of phenol, and reconstruction using the sandwich technique for giant cell tumour (GCT) of bone around the knee.

Methods.

22 women and 14 men aged 19 to 46 (mean, 29.6) years underwent intralesional curettage, use of phenol, and reconstruction using the sandwich technique for GCT of the proximal tibia (n=23) or distal femur (n=13). Two of the cases were recurrences. Two, 18, and 16 tumours were classified as grade I, grade II, and grade III, respectively. Five of the grade III tumours were associated with an extra-articular pathological fracture. Patients underwent intralesional curettage, use of phenol, and reconstruction with allograft, gel foam, and cement (the sandwich technique). Pathological fractures were fixed with plates. Functional outcome was evaluated using the Musculoskeletal Tumor Society (MSTS) score.

Results.

The mean follow-up period was 5 (2.5–11) years. The mean MSTS score was 27.7 out of 30 (standard deviation, 3; range, 16–30). One patient with a grade III tumour in the proximal tibia had a recurrence detected elsewhere after 3 years. Her MSTS score at 2 years was 26. No patient had malignant transformation.

Conclusion.

Intralesional curettage, use of phenol, and reconstruction with allograft, gel foam, and cement (the sandwich technique) for GCT of bone achieved good functional outcome and a low recurrence rate.
Anterior Cervical Disc Replacement for Degenerative Disc Disease
Authors: Munigangaiah Sudarshan , McCabe John P
Published: October 2016

Purpose.

To review the outcomes of anterior cervical disc replacement using the Prestige LP system for degenerative disc disease.

Methods.

Medical records of 12 men and 23 women aged 26 to 66 (mean, 46) years who underwent 48 anterior cervical disc replacements using the Prestige LP system by a single spine surgeon were reviewed. 22 patients underwent one-level disc replacement at C5-C6 (n=13) and C6-C7 (n=9), and 13 patients underwent 2-level disc replacement at C5-C6 and C6-C7 (n=11), C4-C5 and C5-C6 (n=1), and C6-C7 and C7-T1 (n=1). Neck Disability Index (NDI) score, visual analogue scale (VAS) for pain in the neck and arm, and physical and mental component scores of the Short Form 36 were evaluated at week 6 and months 6, 12, 24, 36, and 48.

Results.

The NDI score, VAS score for neck and arm pain, and physical and mental component scores of the Short Form 36 improved significantly after surgery (p<0.001). 80% of patients were satisfied with the treatment. One patient developed a neck haematoma on day 1 and underwent surgical evacuation. Another patient developed Horner's syndrome and achieved partial recovery at 6 weeks and complete recovery at 6 months. No patient had implant-related complications or reoperation.

Conclusion.

The Prestige LP cervical disc implant was safe for one- and 2-level cervical disc replacement.