bluuebunny/crossref_metadata_2025 huggingface dataset:
Palliative Limb Salvage Using a Retrograde Nail-Cement Composite after Intercalary Resection of a Distal Femoral Osteosarcoma: A Case Report
Authors: Kiatisevi Piya , Witoonchart Kiat , Pattarabanjird Narongchai , Thuvasethakul Phairat
Published: October 2016

Malignant lower-limb metaphyseal and diaphyseal bone tumours that have not yet invaded the epiphysis can usually be managed with limb-sparing surgery. Reconstructions using intercalary allografts, autoclaved autografts, extracorporeally irradiated autografts, vascularised autografts, and distraction osteogenesis have all achieved favourable results. In patients with metastatic disease and a short life expectancy, reconstruction with allografts or autografts should be carefully considered because a long recovery period is needed. An intercalary endoprosthesis provides immediate stability, a short recovery period and a low implant failure rate. Nonetheless, it may be expensive when there is inadequate space for stem insertion, necessitating a custom-made endoprosthesis. We present a 12-year-old boy with stage-III osteosarcoma of the metaphysis and diaphysis of the femur who underwent knee joint salvage and reconstruction with a retrograde, locked, intramedullary nail surrounded with methylmethacrylate. At the one-month follow-up, the patient could walk unassisted. At the 2-year follow-up, his Musculoskeletal Tumor Society score was 83%. The patient died from lung metastases at 31 months. He had not experienced any complications with the reconstruction.
Lower-Limb Alignment and Posterior Tibial Slope in Pakistanis: A Radiographic Study
Authors: Khattak Mujahid Jamil , Umer Masood , Davis Edward T , Habib Munira , Ahmed Mehmood
Published: October 2016

Purpose.

To assess the lower-limb alignment and posterior tibial slope in Pakistanis.

Methods.

40 male and 19 female healthy Pakistanis aged 20 to 45 years were recruited. A full weight-bearing anteroposterior radiograph of the entire lower limb of each subject was obtained. The axial alignment was measured based on the centres of the femoral head, knee, and ankle. The tibiofemoral (TF) angle, knee joint line obliquity angle (angle J), and posterior tibial slope were determined.

Results.

The mean TF angle was more varus in men than women (178.4° vs. 180.0°, p<0.001). The mean angle J was more medially inclined in men than women (93.4° vs. 91.4°, p=0.007). The mean medial tibial slope was greater in women than men (16.0° vs. 12.5°, p<0.001). The posterior tibial slope was greater in women than men (14.1° vs. 12.5°, p=0.02), and was greater than the 5° to 10° commonly reported.

Conclusions.

Knee alignment and geometry vary in different population subsets. With regard to total knee arthroplasty, the more medially inclined angle J in Pakistani men suggests that an anteroposterior cut of the distal femur should be in increased external rotation, compared with Pakistani women. Whereas the greater posterior tibial slope in Pakistanis suggests that a proximal tibial cut with a greater posterior tibial slope may reduce the chance of tibial loosening and increase postoperative knee range of motion, especially when using posterior cruciate ligament–retaining designs.
Condylar Buttress Plate versus Fixed Angle Condylar Blade Plate versus Dynamic Condylar Screw for Supracondylar Intra-Articular Distal Femoral Fractures
Authors: Petsatodis George , Chatzisymeon Apostolos , Antonarakos Petros , Givissis Panagiotis , Papadopoulos Pericles , Christodoulou Anastasios
Published: October 2016

Purpose.

To compare outcomes of 3 fixation techniques for intra-articular distal femoral fractures.

Methods.

Records of 59 men and 49 women aged 16 to 80 (mean, 47) years who underwent internal fixation for 116 type-C (complete intra-articular) distal femoral fractures were retrospectively reviewed. According to the AO classification, 25 fractures were type C1 (23 closed and 2 open), 71 type C2 (69 closed and 2 open), and 20 type C3 (16 closed and 4 open). Based on implant availability at the time, all surgeries were performed by a single surgeon using a condylar buttress plate (n=38), a fixed angle (95°) condylar blade plate (n=24), or a dynamic condylar screw (n=54). The mean follow-up period was 11 (range, 4–19) years. At the latest follow-up, functional outcome was classified according to Schatzker and Lambert criteria.

Results.

Functional outcomes were excellent in 64 (55%) of the fractures, good in 37 (32%), moderate in 9 (8%), and poor in 6 (5%). Outcomes in patients treated by the dynamic condylar screw were significantly superior to those treated by the condylar buttress plate (p=0.016) or condylar blade plate (p=0.001). Good-to-excellent results were achieved in 96% vs 84% vs 71% of these patients, respectively. Complication rates were lower in the dynamic condylar screw group than the other 2 groups (pseudarthrosis, 5% vs 11% vs 25%; varus deformity, 4% vs 26% vs 25%; knee stiffness, 0% vs 5% vs 8%, respectively). No implant failure was encountered.

Conclusion.

Dynamic condylar screw fixation for distal femoral fractures achieves better functional outcomes and lower complication rates.
Bone versus Soft-Tissue Sarcomas in the Elderly
Authors: Torigoe Tomoaki , Terakado Atsuhiko , Suehara Yoshiyuki , Kurosawa Hisashi , Yazawa Yasuo , Takagi Tatsuya
Published: October 2016

Purpose.

To compare survival rates in the elderly with bone versus soft-tissue sarcomas.

Methods.

Records of 12 men and 8 women aged 70 to 91 (mean, 77) years with bone or soft-tissue sarcomas were retrospectively reviewed. The grade, size, location, and stage of the sarcomas, as well as their surgical margins, treatment modalities, local recurrence, metastasis, and prognosis were recorded. The mean follow-up period was 37 (range, 2–137) months. Their 5-year survival rates were estimated using the Kaplan-Meier method, and compared with 110 younger controls aged 9 to 69 (mean, 45) years during the same period. There was no significant difference between the older patients and younger controls regarding tumour grading (p=0.068, Chi squared test), stage, and pathological diagnosis.

Results.

Six patients had bone and 14 had soft-tissue sarcomas. Of the 6 bone sarcomas, 3 were malignant fibrous histiocytomas, 2 were osteosarcomas, and one was a chordoma; all were high grade, except for the chordoma. Of the 14 soft-tissue sarcomas, 9 were malignant fibrous histiocytomas, 3 were myxofibrosarcomas, one was a liposarcoma and one an extraskeletal osteosarcoma; all were high grade except for 2 of the myxofibrosarcomas and the liposarcoma. Of the 110 younger controls, 30 had bone and 80 had soft-tissue sarcomas; 44 were low grade and 66 were high grade. The 5-year survival rate was significantly lower in older patients than in younger controls (35% vs 65%, p=0.048). Regarding bone versus soft-tissue sarcomas, the 5-year survival rate was not significantly different among older patients (0% vs 52%, p=0.068) or younger controls (61% vs 66%, p=0.863). The difference was also not significant for older patients versus younger controls with bone sarcomas (0% vs 61%, p=0.284) or soft-tissue sarcomas (52% vs 66%, p=0.368), for older patients with high- versus low-grade sarcomas (17% vs 100%, p=0.314), for older patients with sarcomas located in the limbs versus the trunk (39% vs 38%, p=0.233), as well as for older patients versus younger controls with low-grade sarcomas (100% vs 92%, p=0.512) or high-grade sarcomas (17% vs 46%, p=0.269).

Conclusion.

Survival rates tend to be lower in older patients with sarcomas, especially when the sarcoma is of bone and high grade.
Effect of Gamma Sterilisation and Deep-Freezing on Length and Strength of Fascia Latae
Authors: Kayurapan Agawit , Makadelok Sahachart , Waikakul Saranatra
Published: October 2016

Purpose.

To compare the length and strength of fascia latae after gamma sterilisation and different durations of deep-freezing.

Methods.

50 pieces of fresh porcine fascia latae were randomly divided into 5 groups. Group 1 acted as controls, which were not gamma irradiated and deep-frozen. In groups 2 to 4, fascia latae were incubated in phosphate buffer solution for 4 hours, and then gamma irradiated at 25 kGy. They were preserved at −70°C for one to 3 months, respectively. In group 5, fascia latae were preserved for 3 months, and during the whole process they were fixed on a wooden board to maintain their original length. The maximum tensile strength of each fascia lata was tested at a displacement rate of 1 cm per minute until failure. Results. The maximum tensile strength was not significantly different among groups 1 to 4, but was significantly higher in group 5.

Conclusion.

Gamma sterilisation and deep-freezing had no effect on the strength of fascia latae, but fixation on a board could increase strength.
Plate Osteosynthesis for Severe Olecranon Fractures
Authors: Munoz-Mahamud Ernesto , Fernandez-Valencia Jenaro A , Riba Josep
Published: October 2016

Purpose.

To review outcomes of 10 patients who underwent plate osteosynthesis for severe olecranon fractures.

Methods.

Records of 7 men and 3 women aged 33 to 73 years who underwent plate osteosynthesis for severe olecranon fractures were reviewed. All had some degree of soft-tissue injury; 6 presented with associated fractures. Seven patients were treated with a limited contact dynamic compression plate, and the remaining 3 received a locking compression plate. Patients were followed up for fracture healing, range of motion, nerve damage, heterotopic ossification, infection, hardware complaints, and the need of a secondary surgical procedure. The Mayo Elbow Performance Score (MEPS) was determined at the final follow-up. The patient-answered questionnaire (PAQ) portion of the Liverpool Elbow Score (LES) was evaluated 2 to 37 months later by telephone.

Results.

All patients had bone union. None had nerve damage or heterotopic ossification. Patients 4, 6, and 8 with type-IIIB fractures developed deep infections and severe soft-tissue swelling; all had been treated with the limited contact dynamic compression plate. Four patients underwent plate removal owing to hardware complaints. One patient underwent a secondary procedure to restore complete range of elbow motion. The mean MEPS score was 84 (range, 35–100); 5 patients attained excellent scores, one good, 2 satisfactory, and 2 unsatisfactory. The mean PAQ portion of the LES score was 31 (range, 23–36).

Conclusion.

Plate osteosynthesis achieves satisfactory results for severe olecranon fractures. The deep infection rate is higher in patients with severe soft-tissue injury.
Review Article: Mycobacterium Marinum Infection of the Hand and Wrist
Authors: Cheung Jason Pui-Yin , Fung Boris , Wong Samson Sai-Yin , Ip Wing-Yuk
Published: October 2016

Misdiagnosis and delayed treatment of Mycobacterium marinum infection is common because of its diverse manifestations. This leads to inappropriate use of antimicrobials, extension of the infection from the skin to the tenosynovium, and a poor prognosis (loss of tendons and prolonged immobilisation, secondary to multiple debridements and joint contractures). Clinicians should be aware of this type of infection, especially in subjects at risk (fishermen and aquarium enthusiasts), and those with a history of trauma coupled with exposure to water or marine life. A proactive approach to obtain a biopsy for histopathological and microbiological diagnosis is advised. Anti-mycobacterial treatment should be started promptly. The combined use of rifampicin, ethambutol, and clarithromycin appears to be effective, and debridement is indicated in patients with deep-seated infections.
Tophaceous Pseudogout in the Knee Joint Mimicking a Soft-Tissue Tumour: A Case Report
Authors: Kato Hiroaki , Nishimoto Kazuto , Yoshikawa Tomoaki , Kusuzaki Katsuyuki , Sudo Akihiro
Published: October 2016

Tophaceous pseudogout in the knee joint is rare. We report an 82-year-old man who presented with a one-year history of pain and swelling of the right knee joint. Treatment with non-steroidal anti-inflammatory drugs and aspiration of the joint effusion had not been effective. The mass continued to enlarge, and the patient had difficulty walking. Radiographs and computed tomography showed meniscal calcification with an abnormal soft-tissue mass surrounded by calcification. After excision, massive calcified deposits were seen both inside and on the surface of the tophaceous pseudogout. The deposits showed birefringence under polarised light, suggestive of calcium pyrophosphate dihydrate crystals. At the 2-year follow-up, the patient could walk independently without knee pain or swelling, although his range of knee motion was slightly limited due to joint contracture that developed before surgery.
Cemented Thompson versus Cemented Bipolar Prostheses for Femoral Neck Fractures
Authors: Bauer Stefan , Isenegger Patrick , Gautschi Oliver P , Ho Kwok M , Yates Piers J , Zellweger Rene
Published: October 2016

Purpose.

To compare early functional outcomes, complications, and mortality in elderly patients treated with the less costly, cemented Thompson prosthesis or the cemented bipolar prosthesis in order to identify factors affecting outcomes.

Methods.

Records of 303 patients with femoral neck fractures treated with the cemented Thompson monoblock prosthesis (n=206) or the cemented bipolar prosthesis (n=97) were reviewed. The choice of prosthesis was solely determined by surgeon's preference. Data relating to patient demographics, clinical and residential status, mobility, mental function, mortality, and complications during hospitalisation and rehabilitation were collected.

Results.

After adjusting for confounding variables, independent postoperative indoor mobility was associated with preoperative indoor mobility (p=0.002) and mental function (p=0.001), whereas postoperative outdoor mobility was associated with preoperative outdoor mobility (p=0.003), daily living activity (p=0.02), and mental function (p=0.02). Mortality within 6 months was only associated with poor mental function (p=0.009). At 6-month follow-up, there was no significant difference between the 2 types of prosthesis in terms of functional outcomes, mortality and complication rates.

Conclusion.

In elderly patients with limited mobility, treatment with the bipolar prosthesis was not associated with better short-term outcomes than those receiving the Thompson prosthesis.
Mid- to Long-Term Outcome of Cementless Total Hip Arthroplasty in Younger Patients
Authors: Almeida Fernando , Pino Laura , Silvestre Antonio , Gomar Francisco
Published: October 2016

Purpose.

To assess mid- to long-term outcomes of cementless primary total hip arthroplasty (THA) in younger patients.

Methods.

Records of 28 women and 34 men (75 hips) aged 18 to 55 (mean, 38) years who underwent primary THA using a hydroxyapatite-coated stem and a threaded cup and had been followed up for a mean of 10 (6–15) years were reviewed. 13 of the patients had bilateral THAs. Clinical and radiographic outcomes were evaluated.

Results.

After a minimum follow-up of 7 (range, 7–14) years, 12 (16%) of the hips were revised, of which 8 (11%) were for the cup. The causes for revision were late deep infections (n=2), aseptic loosening of the cup (n=4), and polyethylene wear (n=6). No stem was revised for aseptic loosening. Osteolysis was noted in 24 (38%) hips. Of the 63 unrevised hips, the mean Harris Hip Score was 92 (range, 45–100) and the mean D'Aubigne and Postel score was 17 (range, 9–18). The survival of the threaded cup was 88% at 10 years, using revision surgery as the end point. 27 (41%) of the hips showed signs of polyethylene wear; 15 were >2 mm.

Conclusion.

In younger patients undergoing THA, rates of polyethylene wear and pelvic osteolysis are high, and thus long-term follow-up is crucial.
Differences in Outcome between Maori and Caucasian Patients Undergoing Total Joint Arthroplasty for Osteoarthritis
Authors: Pai Vasu , Pai Vishal , Wright Sophie
Published: October 2016

Purpose.

To compare differences in outcome between Maori and Caucasian patients undergoing total joint arthroplasty for osteoarthritis.

Methods.

45 men and 45 women aged 43 to 87 years who underwent total hip (n=54) or total knee (n=36) arthroplasties by a single surgeon and were followed up for at least one year were prospectively studied. Patients were classified according to American Society of Anesthesiologists (ASA) score. Preoperative comorbidity, length of hospital stay, postoperative complications, and pre- and post-operative outcomes in the 2 groups were compared.

Results.

Maori patients were more likely than Caucasian patients to be obese (body mass index of >30 kg/m2) [37% vs. 15%], diabetic (15% vs. 5%), and smokers (32% vs. 13%). Postoperative complication rates and the lengths of hospital stay in the 2 groups were not significantly different. The ASA score correlated positively with the length of hospital stay; higher ASA scores predicted more prolonged recovery.

Conclusion.

Maori patients were more likely than Caucasian patients to have preoperative comorbidities, but their postoperative length of hospital stay and complication rates were not significantly different.
Femoral Tunnel Widening after Quadrupled Hamstring Anterior Cruciate Ligament Reconstruction
Authors: Cheung Philip , Chan Wai-Lam , Yen Chi-Hung , Cheng Sze-Chung , Woo Siu-Bon , Wong Tsz-Kau , Wong Wing-Cheung
Published: October 2016

Purpose.

To evaluate the extent of femoral tunnel widening after quadrupled hamstring anterior cruciate ligament reconstruction using femoral cross pin fixation in contrast to bioabsorbable screw fixation augmented with Endopearl.

Methods.

16 patients underwent cross pin femoral fixation and the next 15 underwent bioabsorbable screw fixation augmented with Endopearl. The patients were evaluated radiographically for femoral tunnel widening. Standard posteroanterior radiographs of the knee in full extension were taken at postoperative year 2 and 5. The tunnel width was measured at the opening, the widest and the most proximal parts of the femoral tunnel.

Results.

In the femoral cross pin and bioabsorbable screw fixations, the mean femoral tunnel sizes were 7.6 and 8.0 mm, respectively. The overall mean tunnel widening at all measured sites were 2.7 and 1.8 mm at the 2-year follow-up and were 2.5 and 1.8 mm at the 5-year follow-up, respectively. The femoral tunnel widening was greater in the cross pin than the bioabsorbable screw group, but only the difference in the most proximal part was significant (p=0.01 at year 2 and p<0.001 at year 5).

Conclusion.

Femoral tunnel widening was greater in femoral cross pin fixation, probably related to the windshield-wiper and bungee-cord effects. It usually occurred in the first 2 years after the operation and remained static thereafter.
Lateral Closing Wedge Osteotomy with or without Medialisation of the Distal Fragment for Cubitus Varus
Authors: Moon Myung-Sang , Kim Sung-Soo , Kim Seong-Tae , Lee Sung-Rak , Lee Bong-Jin , Jin Jong-Mun , Moon Jeong-Lim
Published: October 2016

Purpose.

To compare treatment outcomes after closing wedge osteotomy and plate fixation for cubitus varus deformity undertaken with or without medialisation of the distal fragment.

Methods.

Records of 21 men and 16 women aged 20 to 34 years who underwent closing wedge osteotomy and plate fixation for cubitus varus deformity with (n=21) or without (n=16) medialisation of the distal fragment were reviewed. A daily alternate flexion-extension splinting was applied for one week for early restoration of full range of motion. The carrying angle and range of motion of the elbow were measured.

Results.

All patients regained the normal carrying angle and range of motion; none had loss of fixation or limitation in range of motion exceeding 10°. Outcomes were excellent in 23 patients and good in 9. A small bony prominence over the lateral condylar region (‘lazy S’ deformity) was noted in group-1 but not group-2 patients.

Conclusion.

Closing wedge supracondylar osteotomy with medialisation of the distal fragment was an effective treatment for cubitus varus deformity and minimised the risk of ‘lazy S’ deformity.
Risk Factors for Surgical Wound Infection in HIV-Positive Patients Undergoing Surgery for Orthopaedic Trauma
Authors: Abalo Anani , Patassi Akouda , James Yaovi Edem , Walla Atsi , Sangare Aly , Dossim Assang
Published: October 2016

Purpose.

To identify risk factors associated with surgical wound infection in patients infected with human immunodeficiency virus (HIV) undergoing surgery for orthopaedic trauma.

Methods.

Records of 29 male and 7 female HIV-positive patients aged 18 to 47 years who underwent surgery for orthopaedic trauma were reviewed. Data on HIV-specific variables (HIV clinical classification, CD4+ lymphocyte count) and highly active antiretroviral therapy were retrieved, as were data on wound class, fracture type, surgery type, surgical wound infections, and outcomes. Possible risk factors associated with surgical wound infection were analysed.

Results.

The median follow-up period was 27 (range, 19–41) months. Of the 36 patients, 14 (39%) developed surgical wound infections (4 were deep and 10 superficial). 89% and 67% of them were in HIV clinical category B and in CD4+ T-lymphocyte category 3, respectively. 12 of these infections resolved after debridement and prolonged antibiotic treatment, and 2 developed chronic osteomyelitis. Four of the patients had non-union. Surgical wound infections were associated with HIV clinical category B (p<0.001), CD4+ T-lymphocyte category of ≥2 (p=0.041), and contaminated wounds (p=0.003).

Conclusion.

Identification of risk factors may help minimise morbidity in HIV-positive patients.
Effect of Risedronate on Bone Resorption during the Consolidation Phase of Distraction Osteogenesis: A Rabbit Model
Authors: Heidari Pedram , Abbaspour Aziz , Baghdadi Taghi , Espandar Ramin , Farzan Mahmoud , Amanpour Saeid , Rasouli Mohammad Reza , Mohagheghi Mohammad Ali , Amiri Hamid Reza , Yasui Natsuo
Published: October 2016

Purpose.

To evaluate the effects of continuous local injection of risedronate in the prevention of bone resorption in a lengthened segment.

Methods.

11 male rabbits underwent subperiosteal osteotomy of the left tibia and an external fixator was applied anteromedially. After a lag phase of one week, a 2-week distraction phase and a 5-week consolidation phase followed. Risedronate was continuously injected into the centre of the distracted segment at a rate of 10 μg/kg/day during the first 14 days of consolidation by a subcutaneously implanted osmotic pump. A control group received purified buffer solution (PBS) using the same protocol. The lengthened bone segments were evaluated using radiography, quantitative computed tomography, and 3-point bending mechanical test.

Results.

Risedronate injection prevented osteopenia as compared to PBS injection. The mean bone mineral content, volumetric density and cross-sectional area of the lengthened segments were significantly higher in the risedronate group than in controls (as much as 65%, 30%, and 25%, respectively). There was no significant difference between the 2 groups regarding the ultimate load to failure.

Conclusion.

Continuous local injection of risedronate into the lengthened segment can prevent osteopenia during distraction osteogenesis but fails to enhance mechanical strength of newly distracted segments.
Intra-Articular Synovial Cyst of the Knee Joint: A Case Report
Authors: Mine Takatomo , Ihara Koichiro , Kawamura Hiroyuki , Kuwabara Yoshikazu
Published: October 2016

Synovial cysts occur secondary to injury, mucinous degeneration or tumours. We report a patient with snapping of the knee joint caused by a synovial cyst located near the patellofemoral joint which developed as a result of minor trauma.
Bilateral Ganglion Cysts of the Cruciate Ligaments: A Case Report
Authors: Willis-Owen Charles A , Konyves Arpad , Martin David K
Published: October 2016

Symptomatic ganglion cysts of the cruciate ligaments are rare, and bilateral cases are extremely rare, with only one reported case in the literature. We report a case of bilateral cruciate ligament ganglion cysts successfully treated with arthroscopic resection, and review the literature regarding aetiology, diagnosis and management.
Intrathoracic Fracture-Dislocation of the Humeral Head: A Case Report
Authors: Abellan Juan F , Melendreras Eduardo , Gimenez Diego J , Carrillo Francisco J , Ruano Luis , Rivkin Jorge
Published: October 2016

Fracture-dislocation of the humeral head into the thoracic cavity is a rare injury. We present one such case in a 70-year-old woman. She presented with a 4-part fracture-dislocation of the proximal humerus, with displacement of the humeral head into the thoracic cavity. She had no signs of acute distress or hemodynamic instability. She underwent hemiarthroplasty of the right shoulder, but the humeral head fragment could not be removed. At 27-month follow-up, the patient had limited mobility of her right shoulder due to axillary nerve palsy but no pain or intrathoracic complications. In the absence of intrathoracic complications, the removal of the humeral head may not be necessary.
The Ten-Year Pattern of Hip Diseases in Singapore
Authors: Singh Gurpal , Krishna Lingaraj , De Shamal Das
Published: October 2016

Purpose.

To review patients with hip diseases undergoing total hip arthroplasty (THA) during 2 different periods.

Methods.

During the periods 1994 to 1996 and 2004 to 2006, 12 men and 28 women (mean age, 57 years) and 55 men and 78 women (mean age, 62 years) underwent THA for hip diseases, respectively. The aetiologies of the hip diseases were classified. Pre-and post-operative radiographs of the pelvis and hip were reviewed. The femoral head-tilt ratio (FHR) was measured.

Results.

The number of patients undergoing THA increased 3-fold over 10 years; the proportion of different aetiologies was similar. Respectively, the most common aetiologies were acetabular dysplasia (33% vs. 40%) and avascular necrosis (33% vs. 42%). Only <5% of the patients had advanced osteoarthritis with no demonstrable cause, most of whom being Caucasians. The overall mean FHR was 1.07. There was no significant difference between male and female subjects.

Conclusion.

The pattern of hip diseases in Singapore remained similar over the 10-year interval, but the number of patients undergoing THA had increased 3-fold.
Serum Levels of Bone Turnover Markers following Total Joint Arthroplasty
Authors: Kenanidis Eustathios I , Potoupnis Michael E , Papavasilioul Kyriakos A , Sayegh Fares E , Petsatodis George E , Kapetanos George A
Published: October 2016

Purpose.

To evaluate changes in serum levels of bone turnover markers during the first year following a total hip or knee arthroplasty (THA or TKA, respectively).

Methods.

34 women and 13 men (mean age, 68 years) with idiopathic hip or knee osteoarthritis underwent elective THA or TKA. The serum levels of (1) osteoprotegerin, (2) nuclear factor-kappa B ligand (RANKL), (3) osteocalcin, and (4) bone-specific alkaline phosphatase (b-ALP) were determined in each patient on preoperative day 1 and postoperative day 3 and 7, and month 2, 4, 6, 8, 10, and 12.

Results.

All 4 markers changed significantly over the 12-month period. At month 12, values of all markers did not return to their preoperative levels uniformly. At month 8, the serum levels of osteoprotegerin, osteocalcin, and b-ALP remained higher than their respective preoperative values. The serum levels of RANKL gradually decreased after month 2, rendering this marker a potential index for fixation.

Conclusions.

Bone turnover markers change following arthroplasties. Postoperative month 8 seems to be a milestone in the normal course of these markers.
Medium-Term Outcome of Total Hip Replacement for Dysplastic Hips in Singapore
Authors: Kumar Jajodia Nirmal , Kumar Jain Sumit , Wang Victor TJ , De Shamal Das
Published: October 2016

Purpose.

To review medium-term outcomes of 46 patients who underwent total hip replacement (THR) for osteoarthritis secondary to dysplastic hips.

Methods.

Records of 58 hips in 6 men and 40 women aged 32 to 76 (mean, 62) years who underwent THR for osteoarthritis secondary to dysplastic hips and had been followed up for a mean of 4 (range, 2–8) years were retrospectively reviewed. The hips were classified according to the Crowe's grading, Sharp's acetabular angle, and centre-edge angle. The radiological uncoverage of acetabular cup (RUAC) index was calculated. The outcomes of THR were evaluated in terms of cup inclination, RUAC index, cup migration, lysis or loosening (radiolucency), heterotopic ossification, component incorporation and positioning, thigh pain, and subsidence.

Results.

51 of the hips were Crowe's type I, 6 were type II, and one was type IV. The mean acetabular angle was 46.3° and the mean centre-edge angle was 15.4°. The mean cup, head, and stem sizes were 50.4 mm, 28.7 mm, and 10.9 mm, respectively. The mean RUAC index was 16.9% and the mean cup inclination was 40.7°. Radiolucency of 1 mm in the acetabular zone I was observed in 16 cases, but only one failed. For cemented and uncemented stems, the most common positioning was neutral and valgus, respectively. Five patients had complications of greater trochanter fracture, aseptic loosening, split calcar, stem loosening, and/or heterotopic ossification.

Conclusion.

Conventional THR can achieve good medium-term results in low-grade dysplastic hips.
The Practice of Unicompartmental Knee Arthroplasty in the United Kingdom
Authors: Schindler Oliver S , Scott W Norman , Scuderi Giles R
Published: October 2016

Purpose.

To survey the current practice of unicompartmental knee arthroplasty (UKA) in the United Kingdom.

Methods.

Questionnaires were sent to all 341 local members of the British Association for Surgery of the Knee to inquire into their practice of UKA, including clinical indications, preoperative investigations, surgical approach, preferences in implant design, and the role of UKA in relation to high tibial osteotomy.

Result.

56% of respondents performed less than 16 UKAs per year, whereas 16.5% performed over 30 per year. 89.5% of the respondents used anteroposterior radiographs as their main investigation tool. Only 30% and 16.5% used posteroanterior 30° flexion and varus/valgus stress radiographs, respectively, despite being better investigation tools. 57% considered arthroscopy, despite its invasive nature. The main contra-indications to UKA were anterior cruciate ligament deficiency with instability (95%), focal grade-III osteoarthritis in the contralateral compartment (87%), and osteoporosis with rheumatoid arthritis (80.5%), but only 59% of respondents considered an inability to passively correct a pre-existing varus or valgus deformity as a contra-indication. 51.5% of respondents preferred minimally invasive approach, 96% preferred cemented fixation, and over two thirds used the mobile bearing design. 72% of respondents expressed preference for total knee arthroplasty over UKA in localised lateral compartment osteoarthritis.

Conclusion.

Modern UKA has gained popularity in properly selected patients with localised medial compartment osteoarthritis, provided the knee is not anterior cruciate ligament deficient and any deformity is passively correctable.
Changing Prophylactic Antibiotic Protocol for Reducing Clostridium Difficile—Associated Diarrhoeal Infections
Authors: Al-Obaydi Waleed , Smith Chris D , Foguet Pedro
Published: October 2016

Purpose.

To determine whether a change in prophylactic antibiotic protocol for orthopaedic surgeries may reduce the frequency of Clostridium difficile–associated diarrhoeal infections.

Methods.

Records of 1331 patients who underwent trauma or elective surgeries involving implantation of metalwork were reviewed. 231 trauma and 394 elective patients who received intravenous cefuroxime–based antibiotic prophylaxis between August 2006 and January 2007 were compared with 216 trauma and 490 elective patients who received a single dose of gentamicin and flucloxacillin or teicoplanin for antibiotic prophylaxis between August 2007 and January 2008. Diarrhoeal faecal specimens of 148 (33%) trauma patients and 106 (12%) elective patients were examined. The outcome variables were the rates of C difficile infection and early deep wound infection.

Results.

There were 32 cases of C difficile–associated diarrhoeal infection and 28 cases of early deep wound infection. The frequency of C difficile–associated diarrhoeal infection decreased after use of the new antibiotic protocol (from 4 to 1%, p=0.004), particularly in the trauma patients (from 8 to 3%, p=0.02); in the elective patients the difference was not significant (from 1 to 0.5%, p=0.27). The change of antibiotic protocol did not significantly affect the incidence of deep wound infections in the trauma (p=0.46) or elective (p=0.90) patients. The rate of C difficile infection was 8-fold higher in the trauma than elective patients, both before and after the change of protocol.

Conclusion.

Changing antibiotic protocol is one way of reducing the incidence of C difficile–associated diarrhoeal infections in orthopaedic patients, without increasing the rate of deep wound infections.
Intramedullary Nailing for Displaced Proximal Humeral Fractures
Authors: Kumar Vinod , Datir Sandeep , Venkateswaran Balachandran
Published: October 2016

Purpose.

To evaluate outcomes of 28 patients who underwent intramedullary nailing for displaced proximal humeral fractures.

Methods.

24 women and 4 men aged 38 to 87 (mean, 65) years underwent intramedullary nailing for displaced proximal humeral fractures. 17 (61%) of them were aged >70 years. Fractures were classified into 2-part (n=8), 3-part (n=17), and 4-part (n=3), and corresponded to AO 11 A3 (n=8), B1 (n=3), B2 (n=9), and C2 (n=8) types. The Constant and Oxford scores were assessed at the final follow-up.

Results.

All patients had bone union except for one who had tuberosity failure. 23 (82%) patients had satisfactory-to-excellent and 5 had poor Constant scores; outcomes were worse with more complex fractures. 20 (71%) patients had satisfactory Oxford scores. Seven (25%) patients had impingement of a nail tip. Other complications included avascular necrosis (n=1), proximal locking screw back-out (n=1), and screw penetration into the joint (n=1).

Conclusion.

Intramedullary nailing provides a stable fixation with minimal soft tissue dissection for displaced proximal humeral fractures. It enables early mobilisation and functional recovery.
Intramedullary Nailing for Diaphyseal Forearm Fractures in Children after Failed Conservative Treatment
Authors: Ali Ayman Mohamed , Abdelaziz Mohamed , El-Lakanney Mohamed Reda
Published: October 2016

Purpose.

To evaluate treatment outcomes after intramedullary nailing using Ender nails for diaphyseal forearm fractures.

Methods.

11 male and 9 female patients aged 6 to 15 (mean, 12) years underwent intramedullary nailing using Ender nails plus cast immobilisation for fractures of both the radius and ulna after conservative treatment had failed.

Results.

After a mean follow-up of 24 (range, 12–30) months, results were excellent in 14 patients, good in 5, and fair in one. None was poor. The mean operating time was 36 minutes. The mean time to bone union was 10 (range, 7–12) weeks. The mean time in the cast was 6 (range, 4–11) weeks. The mean time to implant removal was 8 (range, 6–10) months. All patients regained a full range of elbow movement, except in one who had limited supination and pronation (<20°) due to a degree of malrotation. Two patients had pain owing to nail protrusion. One patient had a superficial infection. One patient had transient neurapraxia.

Conclusion.

Intramedullary nailing using Ender nails plus cast immobilisation is effective for diaphyseal forearm fractures in children after conservative treatment has failed.
Diagnostic Gait Pattern of a Patient with Longstanding Left Femoral Nerve Palsy: A Case Report
Authors: Burke Neil G , Walsh Michael , O'Brien Tim , Synnott Keith
Published: October 2016

The gait pattern of a 35-year-old man with longstanding, left femoral nerve palsy was assessed using 3-dimensional kinematic and kinetic analysis. Stability of his left knee in stance was achieved by manipulating the external moments of the limb so that the ground reaction force passes in front of the knee joint. This compensatory mechanism of locking the knee in extension is reliant on the posterior capsular structures. The patient was managed conservatively and continued to walk without aids.
Anterior Dislocation of Insall Burstein II Total Knee Arthroplasty Secondary to Polyethylene Tibial Post Fracture: A Case Report
Authors: Yan Chun Hoi , Chiu Kwong Yuen , Ng Fu Yuen
Published: October 2016

Anterior dislocation of a posterior stabilised total knee arthroplasty secondary to a polyethylene tibial post fracture is rare. We report one such case in an 89-year-old Chinese woman who had undergone total knee arthroplasty using the Insall Burstein II prosthesis 7 years earlier. The failure was due to sagittal malalignment of the components. Owing to more pronounced anterior bowing of the distal femoral shaft in southern Chinese, neutral component placement is often biased toward hyperextension. When the knee reaches full extension, anterior impingement occurs. Surgeons must therefore take extra care in preoperative planning and bone cutting in this population.
Unipolar versus Bipolar Uncemented Hemiarthroplasty for Elderly Patients with Displaced Intracapsular Femoral Neck Fractures
Authors: Sabnis Bhushan M , Brenkel Ivan J
Published: October 2016

Purpose.

To compare outcomes of unipolar versus bipolar uncemented hemiarthroplasty and determine factors affecting outcomes.

Methods.

433 and 274 elderly patients with displaced intracapsular femoral neck fractures underwent uncemented unipolar hemiarthroplasty and uncemented bipolar hydroxyapatite-coated hemiarthroplasty, respectively. Surgical options were based on the patient's general condition and preinjury mobility status. In the respective groups, the mortality of 377 and 242 patients and the mobility of 270 and 217 patients were reviewed at the 4-month follow-up. Patient age, sex, American Society of Anesthesiologists [ASA] score, mobility, and mortality of the 2 groups were compared.

Results.

Patients who underwent unipolar hemiarthroplasty were significantly older, less fit, and less mobile (p<0.001). Patients who underwent bipolar hemiarthroplasty achieved better outcomes for mortality and mobility (p<0.001). Among patients who were able to walk unaided before injury, more of those having bipolar hemiarthroplasty were able to do so at month 4 than those having unipolar hemiarthroplasty (13% vs. 33%, p<0.001). Mortality within 4 months was associated with age, male gender, and ASA score. When patients were stratified according to age groups, mortality within 4 months was lower in patients having bipolar hemiarthroplasty.

Conclusion.

In elderly patients with femoral neck fractures who were fit and physiologically young, uncemented bipolar hemiarthroplasty seemed to achieve better functional outcome.
Risk Factors of Venous Thromboembolism in Indian Patients with Pelvic-Acetabular Trauma
Authors: Sen Ramesh Kumar , Kumar Amit , Tripathy Sujit Kumar , Aggarwal Sameer , Khandelwal N
Published: October 2016

Purpose.

To determine risk factors of venous thromboembolism (VTE) in Indian patients undergoing surgery for pelvic-acetabular fractures.

Methods.

48 men and 8 women aged 17 to 61 (mean, 36) years who underwent open reduction and internal fixation for pelvic-acetabular fractures were evaluated for VTE in the postoperative period. Pulmonary angiography and indirect computed tomographic venography were used in the hospital, whereas colour Doppler ultrasonography was used in an outpatient setting until postoperative week 6. Patients with evidence of VTE were treated according to the American College of Chest Physician guidelines. Correlations between VTE and putative variable were assessed, and risk factors determined.

Results.

16 patients developed VTE. Six patients with proximal DVT had associated pulmonary embolism (PE). There were 12 cases of proximal deep vein thrombosis (DVT), 2 cases of distal DVT, and 10 cases of PE. The rate of VTE was significantly higher in patients who had predominantly posterior injury (as opposed to anterior injury) [13/27 vs. 3/29, p=0.003], who were operated on in the lateral position (as opposed to the supine position) [13/30 vs. 3/26, p=0.016], or via the Kocher-Langenbeck or combined approach (as opposed to others) [13/30 vs. 3/26, p=0.016]. Patients were more likely to develop VTE when they had predominantly posterior injuries (7.8 fold) or were operated on in a lateral position (2.96 fold) or via the Kocher-Langenbeck approach (2.27 fold).

Conclusion.

Pelvic-acetabular trauma is a significant risk factor for VTE, even in Indians. Patients who have posterior injuries or are operated on in the lateral position, or via the Kocher-Langenbeck approach have a significantly higher risk of VTE.
Correlation of Kyphosis and Wedge Angles with Outcome after Percutaneous Vertebroplasty: A Prospective Cohort Study
Authors: Khurjekar Ketan , Shyam Ashok K , Sancheti Parag K , Sonawane Darshan
Published: October 2016

Purpose.

To evaluate the correlation of kyphosis and wedge angles with pain relief and functional outcome after percutaneous vertebroplasty (PV).

Methods.

15 men and 19 women aged 41 to 85 (mean, 62) years who presented with osteoporotic wedge compression fractures of the dorsolumbar spine below T5 and had failed conservative treatment were included. Patients were assessed before and one year after PV. Kyphosis and wedge angles were measured on standardised radiographs. Pain and function were assessed using the visual analogue scale (VAS) score and the Ronald Morris Disability Questionnaire (RMDQ) score, respectively. Patients were dichotomised based on their preoperative kyphosis (≤10° vs. >10°) and wedge angles (≤7° vs. >7°). Outcomes were classified as excellent, fair, and poor in terms of VAS scores (<3, 3–6, >6) and RMDQ scores (<8, 8–16, >16). Correlations between the kyphosis and wedge angles and VAS and RMDQ scores were assessed.

Results.

VAS and RMDQ scores correlated positively with the kyphosis and wedge angles; the highest correlation was between the VAS score and kyphosis angle ( r=0.93). A significantly greater proportion of excellent outcomes (in terms of RMDQ and VAS scores) were noted in patients with preoperative kyphosis and wedge angles of ≤10° and ≤7°, respectively.

Conclusion.

PV is a viable treatment for vertebral compression fractures with regard to pain relief and improvement of function. Preoperative kyphosis and wedge angles were predictive of post-PV outcomes in terms of VAS and RMDQ scores.
Resumption of Car Driving after Total Hip Replacement
Authors: Abbas Ghulam , Waheed Abdul
Published: October 2016

Purpose.

To assess periods required for resuming car driving in 130 patients who had undergone total hip replacement (THR).

Methods.

80 men and 50 women aged 39 to 80 years who had been driving automatic (n=49) or manual (n=81) cars in the previous 3 months and underwent unilateral primary THR of the right (n=85) or left (n=45) hip were recruited. Patients were advised to resume driving after 6 weeks if they felt comfortable to do so.

Results.

105 (81%) patients were able to resume driving at week 6 to 8; 67 (64%) had had a right THR and 65 (62%) were manual car drivers. 22 (17%) patients were able to do so at week 12. The remaining 3 (2%) patients were not confident to drive even at week 12. No patient reported deterioration in driving ability, whereas 48 (38%) felt a subjective improvement in their driving ability.

Conclusion.

The time to resume driving varies in different patients. The advice should be individualised, depending on the patient's recovery and confidence level.
Blood Reinfusion Combined with Femoral Nerve Block in Total Knee Replacement for Patients with Increased Risk of Bleeding
Authors: Simonsen OH , Gorst-Rasmussen A , Simonsen AB , Jorgensen MB , Rathleff MS , Lundbye-Christensen S
Published: October 2016

Purpose.

To compare patients with increased risk of bleeding who received combined blood reinfusion and femoral nerve block in total knee replacement (TKR) to regular patients treated routinely with respect to pain relief, blood loss, and knee function.

Methods.

In a consecutive series of 67 patients who underwent unilateral TKR, 12 patients with increased risk of bleeding owing to cardiac disease or previous thromboembolic events received continuous femoral nerve block and blood reinfusion, without tranexamic acid (TA) injection. The remaining 55 patients were controls who received standard postoperative treatment (TA injection, local injection of analgesics, and suction drainage without reinfusion). The volume of blood loss (drained or reinfused), pain score (using a visual analogue scale) and knee function (using the Knee Society Score [KSS]) in the 2 groups were compared.

Results.

In the study group, patients were 5 years older and tended to have a lower preoperative KSS function score (35 vs. 45, p=0.08) and a higher function-related pain score (6.5 vs. 6, p=0.10). The mean volume of drained blood wasted in the study group did not differ significantly from the mean total volume of drained blood in the control group (235 vs. 300 ml, p=0.14). Similarly, the mean decrease in postoperative haemoglobin concentration did not differ significantly between the respective groups (2.1 vs. 2.1 mmol/l, p=0.97). A significantly greater proportion of patients received allogenic blood transfusion in the study group than in controls (3/12 vs. 2/55, p<0.01). The study group exhibited significantly higher pain scores during training (1.7 vs. 1.4, p=0.03) and lower escape oxycodone consumption (5 vs. 15 mg/kg, p=0.06) on postoperative day 1 (but not other days). The duration of hospitalisation was also longer (5.5 vs. 4 days, p=0.04).

Conclusion.

In TKR patients with increased risk of bleeding, blood reinfusion combined with femoral nerve block is safe and comparable to standard methods of pain control (local injection of analgesics).
Review Article: Osteochondral Reconstruction and Grafting
Authors: Magill Paul , Byrne Damien P , Baker Joseph F , Mulhall Kevin J
Published: October 2016

ABSTRACT

Osteochondral defects are a challenging problem. Osteochondral reconstruction and grafting techniques potentially benefit both young athletes and elderly osteoarthritis patients. Research on the treatment of osteochondral defects has been carried out, particularly on surgical options, but none shows lasting benefit. More objective evaluation of cartilage injuries and outcomes is needed. We present a review of surgical and non-surgical treatments for osteochondral defects, and their outcomes and costs.
Review Article: Magnetic Resonance Imaging and Computed Tomography in the Diagnosis of Occult Proximal Femur Fractures
Authors: Chatha Hamid A , Ullah Sana , Cheema Zulfiqar Z
Published: October 2016

Electronic databases of MEDLINE, EMBASE, CINAHL, and the Cochrane Library as well as the Google Scholar search engine were used. Studies written in the English language highlighting the use of magnetic resonance imaging (MRI) and computed tomography in diagnosing occult proximal femoral fractures despite negative or equivocal plain radiographs were included. Two reviewers independently extracted data from each article. Raw frequencies for each of the details investigated were calculated. 15 prospective and 7 retrospective studies from 1989 to 2009 were included in this systematic review. A total of 996 patients (mean age, 75 years; standard deviation, 5 years) with suspected occult proximal femur fractures underwent MRI for further assessment. 350 (35%) of the patients tested positive for proximal femoral fractures, of whom 295 (84%) underwent further treatment/surgical interventions. MRI also detected other fractures and soft-tissue injuries. MRI was superior to other imaging modalities in diagnosing occult proximal femoral fractures and should be performed within 24 hours of injury. Early diagnosis and management may avoid substantial displacement and complications, and improve overall mortality and morbidity.