bluuebunny/crossref_metadata_2025 huggingface dataset:
The Need for Multidisciplinary Management of Patients with Upper Thoracic Spine Fractures Caused by High-Velocity Impact: A Review of 32 Surgically Stabilised Cases
Authors: Quinlan JF , Harty JA , O'Byrne JM
Published: October 2016

Purpose.

To analyse the characteristics of patients who underwent surgery for fractures of the upper thoracic spine (T1–T6) in our institution. The thoracic spine is supported by the rib cage and associated ligaments; therefore, displacement and fracture of the upper thoracic spine in healthy young adults require a great force. The relatively narrow spinal canal around the spinal cord in this area could result in severe neurological deficit should fractures occur.

Methods.

The treatment course of 32 patients (26 men and 6 women) who underwent surgery for fractures of the upper thoracic spine between February 1995 and March 2001 was retrospectively reviewed. Parameters of injuries and treatment methods were evaluated.

Results.

Of the 32 patients, 29 were injured in traffic accidents (15 motorcycle and 14 vehicle), 2 in falls, and one by a heavy door falling on his back. 29 patients had spinal fractures at more than one level. 23 patients had complete, 7 had incomplete, and 2 had no neurological deficit. 30 patients required multiple modalities of radiological imaging (in addition to plain radiography) for diagnosis. 20 patients sustained other injuries apart from spinal fractures, 15 of them had associated chest injuries.

Conclusion.

High-velocity fractures of the upper thoracic spine are injuries with devastating consequences, and can result in severe neurological deficit and concomitant injuries. These patients are best treated by a multidisciplinary approach.
Microvascular Density of Rapidly Destructive Arthropathy of the Hip Joint
Authors: Yamakawa T , Sudo A , Tanaka M , Uchida A
Published: October 2016

Purpose.

To assess the vascularity of the femoral head and determine how it is related to the destruction of the arthritic hip joint. The process of destructive arthropathy in arthritic hip joints is variable. Some patients with osteoarthritis of the hip have rapidly progressive destructive changes resulting in the disappearance of the femoral head.

Method.

Six femoral heads from patients diagnosed with rapidly destructive arthropathy and 6 femoral heads from patients with secondary osteoarthritis caused by acetabular dysplasia were analysed to reveal the association between blood capillaries and osteoclasts. The von Willebrand Factor immunostaining and counterstaining with Mayer's haematoxylin were used to label the microvessels and osteoclasts in formalin-fixed, paraffin-embedded specimens of femoral heads. The numbers of immunostained microvessels and osteoclasts in selected regions were counted.

Result.

The microvascular density of the bone surfaces of rapidly progressive arthritic hips was hypervascular. Osteoclasts were also found in increased numbers on the bone surfaces of rapidly progressive arthritic hips. The higher microvascular density coincided with extensive bone destruction and with the increased osteoclast count.

Conclusion.

These findings suggested that hypervascularity of the granulation in the femoral head may be associated with bone and joint destruction.
Review Article: Cemented or Uncemented Femoral Component in Primary Total Hip Replacement? A Review from a Clinical and Radiological Perspective
Authors: Ni GX , Lu WW , Chiu KY , Fong DYT
Published: October 2016

Controversy exists regarding the optimal method of fixation for primary total hip replacement, particularly the femoral component. We performed a systematic literature review to explore whether cemented total hip replacement can achieve better clinical and radiological outcomes. A total of 29 publications were selected using computer-aided and manual searches. A qualitative comparison of results in clinical and radiological changes was then conducted. Most of the literature showed that better short-term clinical and functional outcomes could be obtained from cemented femoral fixation than from uncemented femoral fixation. Results were less clear for the mid-term clinical outcome, though in general, cemented fixation still appeared to show a superior clinical outcome. Radiographic differences are variable and do not seem to correlate with clinical findings. For the short- and mid-term, cemented femoral component is recommended. However, a long-term randomised trial combined with a large cohort study or registry is needed.
Post-Thrombotic Syndrome after Total Hip or Knee Arthroplasty: Incidence in Patients with Asymptomatic Deep Venous Thrombosis
Authors: Schindler OS , Dalziel R
Published: October 2016

Purpose.

To measure the risk of developing signs of post-thrombotic syndrome 15 to 24 months after total hip or knee arthroplasty in patients with asymptomatic deep venous thrombosis (DVT).

Methods.

A total of 85 total knee arthroplasty patients and 47 total hip arthroplasty patients were postoperatively screened for asymptomatic DVT using colour duplex ultrasound.

Results.

The rate of asymptomatic DVT was 37.6% (n=32) in knee patients and 34.0% (n=16) in hip patients. All 32 DVT cases in the knee group had thrombi located below the knee, whereas 6 of the 16 DVT cases in the hip group had thrombi located above the knee, the remaining 10 were below the knee. Patients with proximal thrombi were treated with warfarin for 3 months, whereas patients with distal DVT received 300 mg aspirin daily for the same period. All DVT cases were monitored for up to 12 weeks using repeated colour duplex scans. Signs of thrombus resolution were present at around 6 weeks (range, 4–12 weeks). Clot propagation was observed in 3 cases. In a mean of postoperative 18 months (range, 15–24 months), 28 of the 32 knee patients with asymptomatic DVT were available for follow-up: 11 had transient calf and ankle swelling, 6 had persistent oedema, and the remaining 11 were symptom free. 14 of the 16 hip patients with asymptomatic DVT were available for follow-up: 6 had transient calf and ankle swelling, 4 had persistent oedema, and 4 remained symptom free. 17 patients reported ongoing problems and were re-examined. Signs of mild-to-moderate post-thrombotic syndrome were recorded in 4 knee patients and 3 hip patients.

Conclusions.

Patients with above-knee DVT were much more likely to have post-thrombotic syndrome. Despite thromboprophylaxis with low-molecular-weight heparin, asymptomatic DVT is common after total joint arthroplasty and is responsible for the development of post-thrombotic venous insufficiency and post-thrombotic syndrome in a considerable proportion of patients. Once symptomatic or asymptomatic DVT is established, treatment appears incapable of preventing the occurrence of post-thrombotic syndrome, especially in cases of above-knee DVT. Efforts should hence concentrate on combating DVT propagation and improving DVT prevention.
Arthroscopic Reconstruction of the Anterior Cruciate Ligament Using Bone-Patellar Tendon-Bone Autograft: Experience of the First 100 Cases
Authors: Chaudhary D , Monga P , Joshi D , Easwaran R , Bhatia N , Singh AK
Published: October 2016

Purpose.

To review the results of patients who underwent arthroscopic reconstruction of the anterior cruciate ligament (ACL) via a single incision technique using a bone-patellar tendon-bone autograft.

Methods.

Patients with ACL-deficient knees who were symptomatic and wanted to maintain an active lifestyle or continue sporting activities were included. ACL reconstruction using the bone-patellar tendon-bone graft was performed on 100 patients. One-year follow-up was completed in 78 patients who were then reviewed. The mean age of patients reviewed was 26.8 years (range, 21–39 years), of whom 35 (44.9%) were aged between 26 and 30 years. There were 73 men and 5 women (ratio, 14.6:1). Injuries on the right side outnumbered those on the left (44 versus 34). Sports injuries accounted for 66.7% (n=52) of patients, motor vehicle accidents and household injuries accounted for 30.8% (n=24) and 2.6% (n=2), respectively.

Results.

Excellent and good-to-excellent results were achieved in 7 (9%) and 61 (78.2%) of patients. Residual anterior knee pain (n=18) was the most common complication, followed by difficulty in regaining full range of motion (n=10) and divergence of femoral screw (n=9).

Conclusion.

This procedure provides consistent and reproducible results in carefully selected patients and allows them an early return to sporting activities with minimal residual morbidity.
Bilateral Spontaneous Rupture of Achilles Tendons: A Case Report
Authors: Rao SK , Navadgi BC , Vasdev A
Published: October 2016

Spontaneous bilateral rupture of Achilles tendon is rare. Rupture of the Achilles tendon has been described in patients on oral corticosteroid therapy. The sudden dorsiflexion of the plantar-flexed foot is the usual mechanism of injury. Spontaneous bilateral rupture is common in the degenerated tendon, which is often seen in patients with long-term corticosteroid therapy. This case is unusual because the patient has never taken steroids. We discuss the mechanism of injury and other probable causes.
Pseudoaneurysm of Anterior Tibial Artery following Tibial Nailing: A Case Report
Authors: Inamdar D , Alagappan M , Shyam L , Devadoss S , Devadoss A
Published: October 2016

Interlocking nailing is a widely accepted and performed treatment for tibial shaft fractures. The addition of percutaneously placed transfixation screws increases the stabilisation provided by intramedullary nailing; however, the technical complexity associated with the procedure has introduced new potential complications. We report a pseudoaneurysm of the anterior tibial artery caused by a proximal interlocking screw after intramedullary nailing surgery to repair a tibial shaft fracture. The patient experienced complete relief of symptoms following removal of the nail and the screws, excision of the proximal fibula, resection of the pseudoaneurysm, and ligation of the anterior tibial artery. We recommend the oblique placement of the proximal interlocking screws to prevent this rare complication.
Fusion Rate of Anterior Cervical Plating after Corpectomy
Authors: Cheng NS , Lau PY , Sun LK , Wong NM
Published: October 2016

Purpose.

To evaluate the neurological recovery and fusion rate of patients with myelopathy who were treated with anterior corpectomy and anterior cervical plating. Methods. The results of 17 cervical myelopathy patients who underwent decompression and anterior cervical plating were retrospectively reviewed at a mean follow-up of 2 years.

Results.

By Kurokawa score, 82.4% of patients showed excellent-to-good results. The fusion rates of 2-level and 3-level anterior cervical corpectomy, and of anterior plate fixation were 100%. There were no implant- or graft-related complications. Transient dysphagia in 9 (52.9%) patients resolved after a mean of 3 months (range, 1–9 months).

Conclusion.

The use of anterior cervical plating after anterior corpectomy and fusion with autologous bone graft greatly enhances arthrodesis. The improved fusion rate and low complication rate associated with anterior cervical plating may justify its use in the treatment of cervical spondylotic myelopathy.
Pyogenic Vertebral Osteomyelitis: A Review of 14 Cases
Authors: Nather A , David V , Hee HT , Thambiah J
Published: October 2016

Purpose.

To review and evaluate the management of 14 patients with pyogenic vertebral osteomyelitis at National University Hospital, Singapore between 1998 and 2001.

Methods.

Demographic pattern, predisposing factors, clinical presentation, co-morbidities, microbiology, treatment, and complications of 14 patients were retrospectively reviewed.

Results.

The mean age at presentation was 62.5 years and the male to female ratio was 6:1. The mean follow-up duration was 12.5 months. The most common predisposing condition was diabetes mellitus (n=5). The most common site of infection was the lumbar spine (n=8), followed by the thoracic (n=4) and cervical (n=2) spine. Staphylococcus aureus was the most common causative organism isolated (n=9), followed by methicillin-resistant S aureus (n=3), Pseudomonas pseudomallei (n=1), and Streptococcus agalactiae (n=1). 12 patients were treated surgically: 8 by an anterior approach, 3 by a posterior approach, and one by a combination of the 2. The mean period of antibiotic use was 11.4 weeks. One patient with melioidosis involving the T9 to T11 vertebrae caused by P pseudomallei died of empyema and septicaemia 22 months after presentation.

Conclusion.

Pyogenic vertebral osteomyelitis is not uncommon in the elderly, especially those with predisposing conditions such as diabetes mellitus. Computed tomography–guided needle biopsy is recommended to investigate causative micro-organisms. Aggressive surgical debridement and prolonged antibiotic therapy were necessary in patients with methicillin-resistant S aureus, P pseudomallei, and S agalactiae.
Dall-Miles Cable and Plate Fixation System in the Treatment of Periprosthetic Femoral Fractures: A Review of 20 Cases
Authors: Sandhu R , Avramidis K , Johnson-Nurse C
Published: October 2016

Purpose.

To assess the effectiveness of Dall-Miles cables and plates in the treatment of periprosthetic femoral fractures around hip arthroplasties.

Methods.

We r etrospectively reviewed 20 cases of periprosthetic femoral fracture treated with the Dall-Miles cable and plate system between November 1999 and December 2002 in James Paget Hospital in the United Kingdom. Demographic data, fracture type, and surgical outcome of the patients were reviewed and assessed.

Results.

Of the 20 cases of periprosthetic femoral fracture, one was of Vancouver type A, 15 were of type B1, and 4 were of type C. The mean age at operation was 78.5 years (range, 68–90 years) with a male to female ratio of 11:9. The mean time to union was 3.9 months (range, 3–8 months), and the mean follow-up period was 19.4 months (range, 1–4 years). 15 patients achieved satisfactory results, including 2 delayed unions that healed with a residual varus deformity of 15 degrees in the femoral component. Three patients developed deep-seated wound infections. No nonunion of fractures or fixation system failures occurred.

Conclusion.

The Dall-Miles cable and plate fixation system alone is a sufficient treatment for most periprosthetic femoral fractures. In the management of B1 fractures, there was no significant difference in clinical outcome, despite the various combinations of cables and screws used for stabilisation of the plate. However, in cases of comminution at the fracture site, junctional grafting with morsellised autograft may be used in addition to internal fixation to accelerate union.
Terrible Triad of the Elbow—Role of the Coronoid Process: A Case Report
Authors: Seijas R , Joshi N , Hernández A , Catalán JM , Flores X , Nieto JM
Published: October 2016

Posterior dislocation of the elbow joint with fracture of both the radial head and coronoid process, the so-called ‘terrible triad’, is a complex and difficult-to-treat injury. We report a case of a 34-year-old man with terrible triad of the elbow and associated injuries secondary to a fall. The patient was treated with radial head osteosynthesis, resection of the coronoid process fragments, and stabilisation of the ulnohumeral joint by Kirschner wire transfixation. The sequence of treatment steps is provided. The priority for treating multiple injuries should be established. The integrity of the coronoid process is essential for providing the elbow with maximum functionality.
Missed Diagnosis of Triceps Tendon Rupture: A Case Report and Review of Literature
Authors: Sharma SC , Singh R , Goel T , Singh H
Published: October 2016

Rupture of the triceps tendon is an uncommon injury, probably the rarest of all tendinous ruptures. We present a case of missed diagnosis of triceps tendon rupture. Such diagnosis should be considered when a patient presents with pain and swelling at the back of the elbow after a fall on an outstretched hand.
Osteoid Osteoma Treated with Computed Tomography—Guided Percutaneous Radiofrequency Ablation: A Case Series
Authors: Shinozaki T , Sato J , Watanabe H , Takagishi K , Aoki J , Koyama Y , Takahashi A
Published: October 2016

The nidi of osteoid osteoma are small and difficult to identify precisely; this can necessitate substantial resection of the surrounding normal bone. We applied percutaneous, image-guided radiofrequency ablation to treat 5 patients with osteoid osteoma. The precise location of each nidus was determined using a 3-mm–thick spiral computed tomographic scan. The most appropriate needle pathway was selected to avoid major neural and vascular structures. A 14-gauge core needle was introduced into the nidus and then exchanged for a 17-gauge straight rigid electrode with a 1-cm exposed tip to heat the lesion to 90 degrees centigrade for 5 minutes. Four of the 5 patients were discharged on the day after surgery without any external supports, and were pain-free after a few days. The remaining patient had a pes equinus contracture induced by the penetration of the calf muscles through a posterior approach but was fully recovered 6 days later. The mean follow-up period was 20.6 months. No recurrences or late complications were observed in this series. This case series shows that the computed tomography–guided percutaneous radiofrequency ablation is a simple, minimally invasive, and highly effective technique for the treatment of osteoid osteoma.
Sensory Innervation of Temporomandibular Joint Disk
Authors: Asaki S , Sekikawa M , Kim YT
Published: October 2016

Purpose.

To investigate the nerve endings of the adult temporomandibular joint disk, in particular the presence and configuration of the sensory nerve endings by silver staining and electron microscopy.

Methods.

20 cadaveric temporomandibular joints impregnated with silver stain were studied using an optical microscope; 2 other joints were studied using a transmission electron microscope.

Results.

Free nerve endings were found in the disk parenchyma of all joints. Golgi-Mazzoni corpuscles, Ruffini corpuscles, and articular corpuscles were also observed as sensory nerve end organs. Myelinated and nonmyelinated nerve fibres were visualised in the disk parenchyma using the transmission electron microscope.

Conclusion.

Free nerve endings and sensory nerve end organs are present in the disk parenchyma of the human temporomandibular joint and are associated with sensation and proprioception, just as they are in the acetabular labrum, glenoid labrum, triangular fibrocartilage complex, and meniscus.
Acetabular Morphometry for Determining Hip Dysplasia in the Singaporean Population
Authors: Umer M , Thambyah A , Tan WTJ , De S Das
Published: October 2016

Purpose.

To assess and evaluate the usefulness of 7 morphological measurements of the acetabulum in establishing the prevalence of acetabular dysplasia in the Singaporean population.

Methods.

Standardised plain anteroposterior radiographs of 522 hip joints of 261 asymptomatic patients (mean age, 60 years; range, 16–99 years) were evaluated. The 7 morphological measurements were centre-edge angle, acetabular angle, depth-to-width ratio, roof obliquity, extrusion index, lateral subluxation, and peak-to-edge distance.

Results.

19 (7.3%) patients were acetabular dysplastic (centre-edge angle of <20 degrees). The mean centre-edge angle was 31.2 degrees (range, 5–52 degrees), acetabular angle 39.46 degrees (range, 10–58 degrees), depth-to-width ratio 0.32, roof obliquity 7.86 degrees, extrusion index 0.18, lateral subluxation 9.9 mm, and the peak-to-edge distance 15.65 mm.

Conclusion.

Centre-edge angle was the most useful measurement and correlated significantly with acetabular angle, extrusion index, peak-to-edge distance, and roof obliquity. These preliminary results show a relatively higher rate (7.3%) of acetabular dysplasia in the Singaporean population, compared with other similar but larger Asian studies performed in Hong Kong (1.1%) and Korea (1.8%).
Bone Remodelling after Total Hip Arthroplasty Using an Uncemented Anatomic Femoral Stem: A Three-Year Prospective Study Using Bone Densitometry
Authors: Panisello JJ , Herrero L , Herrera A , Canales V , Martinez A , Cuenca J
Published: October 2016

Purpose.

To evaluate the clinical, radiological, and densitometric changes in the bone-remodelling patterns of femoral stems aligned in neutral, valgus, or varus positions.

Methods.

Between February and October 2000, 70 patients underwent unilateral total hip arthroplasty for primary osteoarthritis using an uncemented Anatomique Benoist Girard (ABG) II stem. 69 patients (30 males and 39 females) with a mean age of 59 years (range, 38–76 years) and a mean body weight of 79.3 kg (range, 29–110 kg) completed 3 years' follow-up on bone remodelling. The clinical, radiological, and densitometric changes of the neutral, valgus, and varus groups were evaluated, and the difference in bone-remodelling patterns between the 3 groups was analysed.

Results.

54 patients had neutrally placed stems, while varus and valgus malalignment occurred in 6 and 9 patients, respectively. Clinical and radiological evaluations were very similar among the 3 groups. Only densitometry could detect traceable changes resulting from the differing biomechanics of the neutral, varus, and valgus stem alignments.

Conclusion.

The ABG II stem design made moderate errors in alignment biomechanically tolerable. Alignment defects had no clinical consequences and resulted in minimal differences in bone remodelling.
Safeness of Simplex-Tobramycin Bone Cement in Patients with Renal Dysfunction Undergoing Total Hip Replacement
Authors: Forsythe ME , Crawford S , Sterling GJ , Whitehouse SL , Crawford R
Published: October 2016

Purpose.

To compare the pharmacokinetic profile of tobramycin in blood, urine, and at the operative site following the use of Simplex-tobramycin bone cement in primary total hip replacement between patients with and without renal dysfunction.

Methods.

Six patients with renal dysfunction underwent cemented primary total hip replacement for osteoarthritis. The elution characteristics of Simplex-tobramycin bone cement in the 6 patients with renal dysfunction were compared with 9 patients who had normal renal function. Blood, urine, and drainage fluid specimens were collected for 72 hours postoperatively.

Results.

Very high concentrations of tobramycin were seen in the drainage fluid of the 2 groups. Mean serum tobramycin levels peaked at postoperative 3 hours, and declined rapidly to negligible levels at 72 hours in both groups. Mean urinary tobramycin concentrations peaked at postoperative 12 hours and declined rapidly until 48 hours in both groups. Urinary tobramycin was excreted significantly more slowly in renal dysfunction group in the first 12 hours, but not thereafter. Although serum creatinine levels of the renal dysfunction group were higher throughout the study period, the difference was not significant. Both groups achieved excellent local delivery of the antibiotic with minimal systemic concentrations.

Conclusion.

Simplex-tobramycin bone cement appears to be an effective and safe means to deliver antibiotic for patients with renal dysfunction who undergo total hip replacement.
Early Results of Prosthetic Hip Replacement for Femoral Neck Fracture in Active Elderly Patients
Authors: Wazir NN , Mukundala VV , Choon DSK
Published: October 2016

Purpose.

To evaluate the short-term clinical and functional outcomes of total hip arthroplasty performed for physiologically active elderly patients with Garden type-3 or -4 femoral neck fracture.

Methods.

Records of 47 consecutive patients (40 female, 7 male) with type-3 or -4 femoral neck fracture (Garden classification) who underwent cemented total hip arthroplasty at our hospital during January 1999 to December 2002 were reviewed. Radiological and clinical (Harris functional hip score and Oxford hip score) assessments of 38 patients were measured with a mean follow-up period of 21 months (range, 4–48 months).

Results.

The mean age of the 47 patients was 75 years (range, 62–89 years). Records of 9 patients were excluded because of death, lost to follow-up, and development of deep infection that necessitated implant removal and excision arthroplasty. The mean Harris hip score of the 38 patients was 83 (range, 59–97), whereas the mean Oxford hip score was 25.2 (range, 14–33). Pain in the hips was absent in 30 patients, 6 had slight pain occasionally, and 2 patients had mild-to-moderate hip discomfort. No signs of aseptic loosening or change in implant position were noted on radiographic assessment. Two cases of dislocation were reduced by closed reduction. Two patients had deep wound infection and were treated with debridement, implant removal, and conversion to girdle stone.

Conclusion.

This short-term study showed that total hip arthroplasty for femoral neck fracture had good postoperative results in functional hip and pain scores. More attention should be paid to coexisting medical illness (e.g. diabetes mellitus, hypertension, and ischaemic heart disease) and prevention of infection.
Comparison of Early Postoperative Rehabilitation Outcome following Total Knee Arthroplasty Using Different Surgical Approaches and Instrumentation
Authors: Weinrauch P , Myers N , Wilkinson M , Dodsworth J , Fitzpatrick P , Whitehouse S
Published: October 2016

Purpose.

To assess early postoperative rehabilitation outcome following computer-assisted total knee arthroplasty (TKA) or standard instrumentation TKA using a medial parapatellar or subvastus approach.

Methods.

A prospective controlled trial of 70 consecutive patients undergoing TKA with a low contact stress rotating platform prosthesis was conducted. Patients were randomised to receive surgery with either computer navigation or standard instrumentation. A medial parapatellar or subvastus approach was used according to the surgeons' preference. Outcome measures included preoperative knee function, intra-operative factors, and postoperative rehabilitation.

Results.

Duration of surgery was significantly longer when using computer navigation; however, operating time decreased with greater experience. A higher incidence and duration of early postoperative quadriceps dysfunction was associated with computer-assisted TKA through the medial parapatellar approach than through the subvastus approach or TKA performed with standard instrumentation. No patient who received surgery through the subvastus approach had a lag of more than 20 degrees, at 48 hours postoperatively, regardless of the instrumentation used.

Conclusion.

Computer-assisted TKA through a medial parapatellar approach was associated with delayed recovery of the quadriceps during early postoperative rehabilitation. This was due to the additional quadriceps dissection required to place the femoral tracking array. The subvastus approach is therefore recommended for computer-assisted TKA.
Pigmented Villonodular Synovitis of the Hip Mimicking Soft-Tissue Sarcoma: A Case Report
Authors: Lee MKS , Choong PFM , Smith PJ , Powell GJ , Slavin JL , Schlicht SM
Published: October 2016

Pigmented villonodular synovitis is a rare and benign but potentially locally aggressive disease that should be considered in younger patients who present with monoarticular joint symptoms and pathology. We present a 30-year-old Sudanese woman with a huge mass arising from the right hip joint. A multimodality radiological approach to investigation and diagnosis is demonstrated and discussed. Histopathological examination of the resected specimen confirmed the diagnosis of pigmented villonodular synovitis with the mass consisting of a proliferation of fibrohistiocytic cells, abundant haemosiderin, foamy histiocytes, and occasional giant cells. The patient made a good recovery, with mobility aided by arm crutches and a hip abduction brace.
Soft-Tissue Sarcoma Mimicking Large Haematoma: A Report of Two Cases and Review of the Literature
Authors: Niimi R , Matsumine A , Kusuzaki K , Okamura A , Matsubara T , Uchida A , Fukutome K
Published: October 2016

We report on 2 patients with soft-tissue sarcomas mimicking large haematomas. Neither patient had a medical history of trauma or bleeding tendency. In a patient with a large leiomyosarcoma in the buttock, insufficient biopsy material from initial surgeries precluded a correct diagnosis. In the second patient with epithelioid sarcoma of the forearm, fasciotomy was repeatedly performed for compartment syndrome arising from the tumour. It is important to reconfirm prior trauma and investigate the clinical course and images of patients with an unusual history of haematoma in the extremities. The possibility of a malignant tumour should be suspected, and repeated biopsies should be performed if necessary.
Total Hip Arthroplasty Infected by Brucella: A Report of Two Cases
Authors: Ruiz-Iban MA , Crespo P , Diaz-Peletier R , Rozado AM , Lopez-Pardo A
Published: October 2016

Infection caused by Brucella following total joint arthroplasty is very rare. We present 2 cases of brucellar infection following total hip arthroplasty (THA). A 66-year-old woman who had prolonged contact with cattle presented with pain at the thigh and groin areas. The patient had undergone an uncemented THA for a hip fracture 3 years previously. Cultures of articular liquid were positive for Brucella abortus. The implant was loosened and was managed with a 2-stage re-implantation. A 71-year-old man presented with painless suppuration of the hip joint through the scar from previous surgeries. Radiography demonstrated a well-integrated THA. When postoperative cultures were found positive for Brucella melitensis, antibiotic treatment of rifampicin 900 mg, streptomycin 1 g, and doxycycline 200 mg daily were prescribed. At 5.5-year and 5-year follow-up, respectively, both patients were asymptomatic and free of infection with well-integrated implants. As the Brucella pathogen is highly susceptible to antibiotics, standard 2-stage revision arthroplasty for loosened implant or debridement and antibiotic treatment for well-fixed implant should suffice.
Extracorporeal Shock Wave Treatment for Defective Nonunion of the Radius: A Rabbit Model
Authors: Bulut O , Eroglu M , Ozturk H , Tezeren G , Bulut S , Koptagel E
Published: October 2016

Purpose.

To investigate the effect of extracorporeal shock wave treatment (ESWT) on bony union using volume analysis of the callus mass by computed tomography and histology.

Methods.

Both radii of 13 rabbits were osteotomised and a defective bony nonunion created by placing a polyethylene pad between the osteotomy site for 40 days. Nonunion was confirmed by radiography using Lane-Sandhu criteria. ESWT (14 kW, 0.46 mJ/mm2, 1000 shock waves) was applied to the right radius of the rabbits. The left radius served as a control. Five rabbits were killed 4 weeks after ESWT (group 1) and 8 after 6 weeks (group 2). Volume analysis of the callus mass was performed using computed tomography and the bone healing process was assessed by histology.

Results.

In group 1, callus volume on the treated side was invariably greater than that on the control side; the difference being statistically significant (p=0.032). In group 2, the callus volume of the treated side was greater than that of the control side, except in rabbits 4 and 9. Only after excluding the findings from the latter did the difference attain statistical significance (p=0.020). Histology confirmed that the bone-healing process was faster in the treated side.

Conclusion.

ESWT enhanced the bone-healing process by increasing both volume and speed of callus formation.
Pelvic Reconstruction Using Saddle Prosthesis following Limb Salvage Operation for Periacetabular Tumour
Authors: Kitagawa Y , Ek ET , Choong PFM
Published: October 2016

Purpose.

To assess the clinical results of pelvic reconstruction using a saddle prosthesis following limb salvage operation for periacetabular tumour.

Methods.

12 patients with sarcoma and 4 with metastasis involving the pelvis were treated using the saddle prosthesis between 1995 and 2003 inclusive. Wide pelvic resection was performed for all patients with sarcoma and one with a metastatic lesion; intralesional excision of the acetabulum was undertaken for the remaining 3 patients with metastatic lesions. Oncologic prognosis, operation time, postoperative function, and complications were assessed retrospectively.

Results.

Of the 12 patients with sarcomas, 5 were alive without evidence of recurrence after a mean follow-up of 37 months, one was alive with disease, 3 died of the disease, and 3 of other medical conditions. Respective mean postoperative functional scores according to the Musculoskeletal Tumor Society–International Symposium on Limb Salvage system and the Toronto Extremity Salvage Score were 53 and 64% in patients undergoing wide acetabular resection, and 30 and 42% in patients undergoing intralesional excision of the acetabulum. In patients undergoing wide acetabular resection and intralesional excision of the acetabulum, the mean operation times were 391 and 162 minutes respectively, whereas the mean times to ambulation were 7 and 4 days respectively. Major complications included infection and dislocation.

Conclusion.

Saddle prosthesis arthroplasty is a useful option for pelvic reconstruction following resection of acetabular malignancies. It is associated with a short operation time, rapid recovery, and moderately good postoperative function, but a relatively high risk of complications.
Factors That Affect the Healing Index of Metacarpal Lengthening: A Retrospective Study
Authors: Bozan ME , Altinel L , Kuru I , Maralcan G , Acar M , Durmaz H
Published: October 2016

Purpose.

To determine factors that affect healing index and consolidation time following lengthening of congenitally short metacarpals (brachymetacarpia).

Methods.

18 metacarpals of 8 young women (mean age, 18.6 years) were lengthened using the callus distraction technique. The results, including healing index and consolidation time, were analysed and compared with those in the literature.

Results.

The mean length increase was 16.5 mm (55% of the original length of 30 mm). Age was positively correlated with healing index and consolidation time: younger patients healed faster than older patients. Healing index differed significantly between patients aged 0 to 18 years and those aged 19 to 30 years (p=0.002). Comparison of our results with 9 previous studies confirmed that increased age was associated with a greater healing index and consolidation time. Conversely, the faster the distraction rate, the less the healing index and consolidation time.

Conclusion.

Age has the most effect on healing index and consolidation time. Metacarpal lengthening using callus distraction is recommended. Adolescence is the most appropriate time to perform distraction lengthening of a congenitally short metacarpal. This will avoid additional lengthening of normal metacarpals prior to epiphyseal closure.
Functional Outcome of the Hand following Flexor Tendon Repair at the ‘No Man's Land’
Authors: Chan TK , Ho CO , Lee WK , Fung YK , Law YF , Tsang CY
Published: October 2016

Purpose.

To evaluate the functional outcome of the hand following flexor tendon repair at ‘no man's land’ using 2 strands of a modified Kessler core suture and combined controlled motion rehabilitation protocol.

Methods.

Records of 31 zone-2 flexor tendon injuries in 21 digits of 16 patients between July 2000 and June 2005 were reviewed retrospectively. The injured tendons were repaired within 24 hours using 2 strands of a modified Kessler core suture, reinforced by a continuous circumferential epitendon suture. All patients completed a rehabilitation protocol that included active extension against a rubber band, passive flexion, and controlled passive extension and passive flexion exercises. Functional outcome of the fingers was assessed using the Buck-Gramcko II score. Hand grip strength, rehabilitation period, and rupture rate were also measured.

Results.

17 (81%) out of 21 digits in 15 out of 16 patients achieved an excellent-to-good functional grade. The remaining patient with concomitant injuries to 4 (19%) digits attained a poor functional grade, attributable to poor compliance with the rehabilitation protocol. The mean rehabilitation period was 130 days and the mean grip strength was 78% that of the uninjured side. Concomitant digital nerve injury did not adversely affect the final outcome. Only one (4.8%) patient experienced a rupture.

Conclusion.

The surgical method and rehabilitation protocol used for zone-2 flexor tendon injury is safe and results in a reasonably good functional outcome.
Extraskeletal Osteochondroma in the Nape of the Neck: A Case Report
Authors: Singh R , Sharma AK , Magu NK , Kaur KP , Sen R , Magu S
Published: October 2016

Extraskeletal osteochondroma in the nape of the neck is rare and its pathological diagnosis is based on radiological and histopathological examination. It is vital that such a diagnosis be considered when a discrete, ossified mass is localised in soft tissues, even at atypical sites. Differential diagnoses include myositis ossificans, a lipomatous lesion, a pseudomalignant osseous tumour, an ossifying fibromyxoid tumour, an extraskeletal chondroma with endochondral ossification, synovial (osteo) chondromatosis, tumoural calcinosis, a synovial sarcoma, and an extraskeletal osteosarcoma. Clinical awareness of this benign entity is important as no malignant transformation or metastasis has been reported. Marginal excision with histopathological identification is the treatment of choice.
Saddle Embolism after Corrective Femoral Osteotomy: A Case Report
Authors: Sekiya H , Noguchi K , Ohashi Y , Kariya Y , Hoshino Y , Konishi H
Published: October 2016

We present a case of recurrent saddle embolism 6 days and 9 days following corrective osteotomy of the left femur in a 64-year-old man with a history of atrial fibrillation. Although saddle embolism is a relatively rare event, orthopaedic surgeons should be aware of this condition.
Thorn Prick Osteomyelitis of the Foot in Barefoot Walkers: A Report of Four Cases
Authors: Vidyadhara S , Rao SK
Published: October 2016

Walking barefoot is common in developing countries and the feet are therefore exposed to a variety of trivial injuries, some of which lead to cellulitis or abscess formation. If left untreated or improperly managed, osteomyelitis or septic arthritis, usually involving the heel or metatarsals, may follow. In countries with limited resources, the emphasis should be on clinical assessment for diagnosis, and good surgical technique for treatment. We report 4 patients with thorn prick osteomyelitis of the foot due to walking barefoot. All were treated with thorn removal, surgical debridement, and oral ofloxacin. Surgical removal of the thorn is the key to successful treatment and to avoiding recurrent infection.
Treatment for Unstable Intertrochanteric Fractures in Elderly Patients: Internal Fixation versus Cone Hemiarthroplasty
Authors: Kayali C , Agus H , Ozluk S , Sanli C
Published: October 2016

Purpose.

To evaluate the effectiveness of internal fixation versus cone hemiarthroplasty for the treatment of unstable intertrochanteric fractures in elderly patients.

Methods.

The choice of treatment was based on the year of admission: between 2001 and 2003, 42 patients (mean age, 73 years) underwent cone hemiarthroplasty using a cementless press fit through a posterior approach, whereas between 1999 and 2001, 45 patients (mean age, 75 years) underwent internal fixation using a dynamic hip screw through a lateral approach in a supine position. Patients with stable fractures with intact lesser trochanter, immobility before injury, age younger than 60 years, or with associated injuries (such as another fracture) were excluded. Patients were encouraged active rehabilitation in bed. Bony union was determined by clinical and radiological examinations. Patients were followed up at 6-week intervals in the first sixth months and every 3 months thereafter until bony union was achieved. In the final follow-up, 32 cone hemiarthroplasty patients and 38 internal fixation patients were available for evaluation according to Merle d'Aubigne and Postel criteria.

Results.

There were no significant differences between the 2 groups in terms of sex, age, fracture type, Singh index, follow-up period, hospital stay, operating time, and receipt of blood transfusions. Clinical results of both groups were similar. Hemiarthroplasty patients were allowed full weight bearing significantly earlier than the internal fixation patients.

Conclusion.

Cone hemiarthroplasty can be an alternative treatment for unstable intertrochanteric fractures in elderly patients so as to achieve earlier mobilisation.
Elderly Patients with Two Episodes of Fragility Hip Fractures Form a Special Subgroup
Authors: Ip D , Ip FK
Published: October 2016

Purpose.

To identify the demographic features of patients aged 65 years or older admitted with 2 episodes of fragility hip fractures.

Methods.

From July 2003 to December 2004 inclusive, 50 consecutive elderly patients underwent surgery for a second episode of hip fracture. Patients in a very poor physical condition and therefore unfit for surgery were excluded. Risk factors of fractures in both episodes and whether risk factors were corrected after the first episode were analysed. Detailed radiological assessment and charting of elderly mobility scores and Barthel index were completed and the one-year mortality rate documented. The rehabilitation periods for the 2 episodes of hip fracture were compared.

Results.

Most patients were female and had trochanteric fractures. In patients aged 65 to 75 years, the incidence of femoral neck fracture occurred as often as trochanteric fracture; while trochanteric fracture was predominant in older patients. Subclinical osteomalacia and undiagnosed hyperthyroidism was found in 3 of the 7 younger patients. Only 30% of them were on treatment for osteoporosis after the first fracture, which underlines the importance of osteoporosis treatment in these patients.

Conclusion.

Elderly patients with 2 episodes of fragility hip fractures form a special subgroup among geriatric hip fracture patients. Fall prevention programmes and treatment for osteoporosis are recommended.
Intra-Operative Error during Austin Moore Hemiarthroplasty
Authors: Weinrauch P
Published: October 2016

Purpose.

To examine the frequency of technical errors during implantation of the Austin Moore prosthesis in a public hospital.

Methods.

Radiographs and charts of 147 consecutive uncemented Austin Moore hemiarthoplasty patients were retrospectively reviewed with particular reference to intra-operative errors associated with early failure of the prosthesis.

Results.

48% of the patients had at least one error pertinent to implantation and 14% sustained intraoperative fractures. The error rates between relatively junior doctors and consultants were not significantly different.

Conclusion.

The uncemented Austin Moore prosthesis is a technically demanding prosthesis that is difficult to implant well. Greater selectivity should be exercised when considering its use for femoral neck fractures.
Modified Ilizarov Technique for Infected Nonunion of the Femur: The Principle of Distraction-Compression Osteogenesis
Authors: Krishnan A , Pamecha C , Patwa JJ
Published: October 2016

Purpose.

To evaluate the treatment outcome of the modified Ilizarov technique in infected nonunion of the femur.

Methods.

Between 1989 and 2002, records of 20 patients with infected nonunion of the femur treated with the modified Ilizarov technique were retrospectively reviewed. The modified Ilizarov frame was fixed after necrectomy of the dead infected bone and tissues. A proximal or distal corticotomy was performed following biological principles. For regeneration of gap, segmental transport was performed in 11 patients with a gap of more than 5 cm; acute docking followed by lengthening at the corticotomy site was performed in 9 patients with a gap of smaller than 5 cm. Mobilisation was started early with active participation of the physical therapist and the patients. Bone and functional results were measured and complications were categorised according to the Association for the Study and Application of the Method of Ilizarov guidelines.

Results.

The mean follow-up period was 62.8 months. Bony union and eradication of the infection was achieved in all patients except one who underwent amputation due to uncontrolled infection. Bone results were excellent in 13 patients, good in 4, fair in one, poor in one, and treatment failure (amputation) in one. Functional results were excellent in 3 patients, good in 9, fair in 3, poor in 4, and failure in one. A total of 71 complications occurred: 35 problems, 6 obstacles, and 30 true complications. The mean healing index was 38.3 day/cm (standard deviation, 1.6 day/cm).

Conclusion.

The Ilizarov technique is a good salvage operation for infected nonunion of the femur. Limb salvage is preferable to prosthesis if the limb is viable, adequately innervated and the patient is mentally and financially committed to save the limb.
Acute Compression and Lengthening by the Ilizarov Technique for Infected Nonunion of the Tibia with Large Bone Defects
Authors: Magadum MP , Yadav CM Basavaraj , Phaneesha MS , Ramesh LJ
Published: October 2016

Purpose.

To assess the Ilizarov technique in treating large infected tibial defects by resection of the infected focus, its acute compression, and gradual distant site lengthening.

Methods.

27 men (mean age, 39 years) with infected nonunion and large bone defects of the tibia underwent complete resection of the nonunion site, debridement, sequestrectomy, lavage, and Ilizarov ring fixator application. Patients underwent acute compression of the defect site, followed by distant site metaphyseal corticotomy for simultaneous lengthening. The mean length of resection was 10 (range, 6–17) cm. The mean follow-up was 27 (range, 25–39) months.

Results.

The mean lengthening achieved was 10 cm, mean union time 6.3 months, and mean duration of consolidation 10.2 months. Functional results were excellent in 19 patients and good in 5. The union time was longer in older patients.

Conclusion.

Acute compression and simultaneous lengthening can be used safely for treatment of large bone defects in the tibia. This avoids secondary operations at the docking site and reduces the duration of treatment.