bluuebunny/crossref_metadata_2025 huggingface dataset:
Kirschner Wire Fixations for Scapholunate Dissociation: A Cadaveric, Biomechanical Study
Authors: Jakubietz Michael G , Zahn Robert , Gruenert Joerg G , Waschke Jens , Meffert Rainer H , Jakubietz Rafael G
Published: October 2016

Purpose.

To compare 5 different Kirschner wire fixation techniques in terms of the failure loads seen as scapholunate (SL) dissociation in a cadaveric, biomechanical study.

Methods.

10 fresh-frozen, finger-amputated wrists with sectioned SL ligaments from 3 male and 2 female cadavers were tested. The change of SL angle, SL dissociation, and the load to failure of the 5 different Kirschner wire fixation techniques (using 1.4-mm Kirschner wires) were compared using an axial loading testing machine. The techniques were: (1) SL fixation (using one wire), (2) SL fixation (using 2 wires), (3) SL and scaphocapitate (SC) fixation, (4) SL, SC, and capitolunate (CL) fixation, and (5) CL fixation alone.

Results.

There was no significant difference between SL fixations using one or 2 wires. The force for SL dissociation was significantly greater in the SL-SC fixation than the SL fixation using one wire (p=0.003). The SL-SC-CL fixation was not significantly stronger than the SL-SC fixation.

Conclusion.

The SL-SC fixation achieved adequate stabilisation of both carpal rows with minimal biological impairment.
Magnetic Resonance Arthrography for Assessing Severity of Glenohumeral Labroligamentous Lesions
Authors: Jana Manisha , Srivastava Deep Narayan , Sharma Raju , Gamanagatti Shivanand , Nag HL , Mittal Ravi , Upadhyay Ashish Dutt
Published: October 2016

Purpose.

To compare magnetic resonance (MR) arthrography and arthroscopy as a means of assessing the severity of labral tear in anterior glenohumeral instability.

Methods.

52 patients presenting with traumatic recurrent anterior shoulder instability were evaluated using MR arthrography; 30 shoulders with a labroligamentous lesion were treated with arthroscopic Bankart repair. Their MR arthrographic images were interpreted by 3 senior musculoskeletal radiologists, and a radiological diagnosis was reached by consensus. The sensitivity and positive predictive values of MR arthrography for detecting a labral tear were determined. Agreement between MR arthrography and arthroscopy in terms of the width and depth of the labral tear was analysed.

Results.

On arthroscopy, a labroligamentous lesion (Bankart lesion and its variants) was present in all the 30 shoulders. Agreement between the MR arthrography and arthroscopy in terms of the width and depth of the labral tears was good.

Conclusion.

MR arthrography is an accurate means of assessing the severity of anterior labroligamentous lesions and yields a good correlation with arthroscopy.
Review Article: Risk Factors of Infection following Total Knee Arthroplasty
Authors: Rodriguez-Merchan E Carlos
Published: October 2016

22 Pub Med articles in English were identified using the key words: ‘risk factors’, ‘infection’, and ‘primary total knee arthroplasty (TKA)’. The 10 most relevant articles were reviewed. In one study, obesity and diabetes were considered risk factors for infection following TKA. In another study, postoperative infection correlated with a history of open reduction and internal fixation, male gender, remnants of previous internal fixation material, and body mass index. In yet another study, the risk factors were (in decreasing order of significance): congestive heart failure, chronic pulmonary disease, preoperative anaemia, diabetes, depression, renal disease, pulmonary circulation disorders, obesity, rheumatologic disease, psychoses, metastatic tumour, peripheral vascular disease, and valvular disease.
Cauda Equina Syndrome following Sacral Fractures: A Report of Three Cases
Authors: Aresti Nick , Murugachandran Govin , Shetty Rohit
Published: October 2016

We report 3 patients with cauda equina syndrome (CES) secondary to a sacral fracture. The difficulty in early diagnosis of CES and the lack of evidence and guidance on treatment are highlighted. When there is a sacral fracture, CES should be suspected. Thorough clinical examination including digital rectal examinations and bladder function quantification is advised. The threshold for performing computed tomography and/or magnetic resonance imaging of the pelvis should be low. Patients should be treated by a multi-disciplinary team with both orthopaedic and neurosurgical input. Further studies are needed to identify the timing and to which patients surgical decompression should be performed.
Calcium Pyrophosphate Dihydrate Crystal Deposition of Multiple Lumbar Facet Joints: A Case Report
Authors: bin Mohamed Namazie Mohamed Ridzwan , Fosbender Murray R
Published: October 2016

Pseudogout of the lumbar facet joints is rare. We report on a 69-year-old woman with 2-level symptomatic synovial cysts of the facet joints caused by calcium pyrophosphate dihydrate crystal deposition. She underwent surgical decompression for sciatica and low back pain. At one-year follow-up, she had recovered completely.
Mating of a Prostalac Spacer with an Intramedullary Nail for Reconstruction of an Infected Interprosthetic Femoral Shaft Fracture: A Case Report
Authors: Kamath Atul F , Austin Daniel , Lee Gwo-Chin
Published: October 2016

Reconstruction for concurrent infection of an ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) is a challenge. We report a 2-stage reconstruction of a THA for chronic infection of both the THA and TKA with severe femoral bone loss secondary to interprosthetic fractures. The reconstruction involved using a custom-made, temporary, antibiotic-impregnated PROSTALAC spacer mated with an intramedullary nail. The acetabulum was then exposed and the necrotic cartilage was removed and curetted. The acetabulum was reamed to accept a PROSTALAC acetabular shell. The shell was cemented into the acetabulum with antibiotic cement. The custom-made spacer was then inserted distally first into the tibia. The distal end of the intramedullary nail was interlocked with a bicortical bolt to minimise nail rotation. Antibiotic-impregnated cement was moulded around the nail and spacer. The proximal end of the spacer was then reduced into the acetabular socket, and the joint was irrigated and the wound closed. A customised abduction brace was fitted, and partial weight bearing was allowed. Sufficient leg length, soft-tissue tension, and range of hip motion were restored, and a total femur and constrained liner was re-implanted 4 months later. Mating of an intramedullary nail with a PROSTALAC spacer is a viable reconstructive option.
Shelf Syndrome of the Knee in Elderly People: A Report of Three Cases
Authors: Mine Takatomo , Ihara Koichiro , Kawamura Hiroyuki , Seto Takayuki , Umehara Keitaro
Published: October 2016

Shelf syndrome occurs mainly in younger people (particularly athletes) and rarely in elderly people. We report on 3 elderly patients with a medial synovial plica causing severe pain and locked knees. They had had no symptoms in their early or middle life. After removal of the shelf, the symptoms improved considerably. Although shelf syndrome is rare in the elderly, it should be suspected whenever severe pain and a locked knee are present.
Septic Arthritis of the Knee Associated with Calf Abscess
Authors: Izumi Masashi , Ikeuchi Masahiko , Tani Toshikazu
Published: October 2016

Septic arthritis associated with extra-articular abscess is rare. We report on 2 non-rheumatic patients with septic arthritis of the knee associated with calf abscess. Magnetic resonance imaging showed a distinct leakage pathway from the knee joint in each patient. One was a ruptured popliteal cyst (posteromedial). Another was a pathologic popliteus hiatus (posterolateral). These patients underwent open drainage of the calf abscess via a small incision, followed by arthroscopic debridement of the knee. Careful palpation of the lower leg, followed by magnetic resonance imaging and needle aspiration, is important to exclude a possible extra-articular abscess regardless of the presence of a popliteal cyst.
Minimally Invasive Plate Osteosynthesis Using a Locking Compression Plate for Diaphyseal Humeral Fractures
Authors: Malhan Sachit , Thomas Simon , Srivastav Shekhar , Agarwal Shekhar , Mittal Vivek , Nadkarni Biren , Gulati Divesh
Published: October 2016

Purpose.

To assess outcomes of minimally invasive plate osteosynthesis (MIPO) using a locking compression plate (LCP) for 42 humeral shaft fractures.

Methods.

28 men and 14 women aged 18 to 68 (mean, 34; median, 29) years underwent closed reduction and MIPO using a LCP for type 12-A (n=26) and type 12-B (n=16) humeral shaft fractures. Eight of the patients were aged ≥50 years. Patients were followed up monthly until radiological union in at least 3 of the 4 cortices. Functional assessment was based on the Disabilities of Arm, Shoulder and Hand (DASH) score.

Results.

The mean follow-up period was 25 (range, 14–35) months. The mean DASH score was 35.1 at month 3 and improved to 8.9 at month 6 and 5.2 at year 1. The mean angulation was 4° in the coronal plane and 7° in the sagittal plane. All fractures united after a mean of 14 weeks. Two patients with transverse fractures had delayed union and received bone marrow injections at 12 or 13 weeks; they achieved union at week 20. One patient developed a radial nerve palsy immediately after surgery and underwent surgical exploration through the anterolateral approach. The plate was re-applied, and the nerve recovered in 48 hours with full power in all the muscle groups.

Conclusion.

MIPO with LCP is a safe and effective technique for fixation of diaphyseal humeral fractures, and results in faster bone union, better cosmesis, and minimal complications.
Intramedullary Nailing Supplemented with Poller Screws for Proximal Tibial Fractures
Authors: Kulkarni Sunil G , Varshneya Ankit , Kulkarni Shreenath , Kulkarni Govind S , Kulkarni Milind G , Kulkarni Vidhisha S , Kulkarni Ruta M
Published: October 2016

Purpose.

To evaluate outcome of intramedullary nailing supplemented with Poller screws for proximal tibial fractures using small diameter nails.

Methods.

50 men and 20 women (75 fractures) aged 18 to 65 (mean, 33) years underwent intramedullary nailing supplemented with Poller screws for acutely displaced fractures (n=60) or for delayed union (n=10) or mal-union (n=5) of the proximal metadiaphyseal tibia. 88% of the fractures were caused by road traffic accidents. 54 cases had closed fractures and 21 had grade I or II compound fractures. Clinical and radiological outcome was evaluated.

Results.

In 69 cases, healing occurred after a mean of 4.2 (range, 3–9) months. In 5 cases, there was nonunion, which was resolved by bone grafting. One case was mal-united. 63 patients recovered a full range of knee motion (0°–130°), and the remaining 7 attained flexion of 0° to 90°. According to the knee rating scale of the Hospital for Special Surgery, outcome was excellent in 50 patients, good in 14, poor in 3, and failed in 3 at month 12, and remained so after a mean follow-up of 30.8 months. Postoperatively, 74 cases had <5° of varus or valgus malalignment, and only one developed varus of +7°. 65 cases exhibited no deformity, 7 had a deformity of <3°, and 3 had a deformity of 4° to 9°.

Conclusion.

Poller screws help maintain fixation of intramedullary nailing and alignment of fractures.
Benefits of Using Modern Cementing Techniques in the Acetabulum: The Rim Cutter
Authors: Darmanis Spyros N , Hubble Matthew JW , Howell Jonathan R , Whitehouse Sarah L , Timperley A John
Published: October 2016

Purpose.

To compare radiological records of 90 consecutive patients who underwent cemented total hip arthroplasty (THA) with or without use of the Rim Cutter to prepare the acetabulum.

Methods.

The acetabulum of 45 patients was prepared using the Rim Cutter, whereas the device was not used in the other 45 patients. Postoperative radiographs were evaluated using a digital templating system to measure (1) the positions of the operated hips with respect to the normal, contralateral hips (the centre of rotation of the socket, the height of the centre of rotation from the teardrop, and lateralisation of the centre of rotation from the teardrop) and (2) the uniformity and width of the cement mantle in the 3 DeLee Charnley acetabular zones, and the number of radiolucencies in these zones.

Results.

The study group showed improved radiological parameters and were closer to the anatomic centre of rotation both vertically (1.5 vs. 3.7 mm, p<0.001) and horizontally (1.8 vs. 4.4 mm, p<0.001) and had consistently thicker and more uniform cement mantles (p<0.001). There were 2 radiolucent lines in the control group but none in the study group.

Conclusion.

The Rim Cutter resulted in more accurate placement of the centre of rotation of a cemented prosthetic socket, and produced a thicker, more congruent cement mantle with fewer radiolucent lines.
Mid-Term Outcome of a Modular, Cementless, Proximally Hydroxyapatite-Coated, Anatomic Femoral Stem
Authors: Cossetto David J , Goudar Anil
Published: October 2016

Purpose.

To report the mid-term outcome of a modular, cementless, proximally hydroxyapatite-coated, anatomic femoral stem in total hip arthroplasty (THA).

Methods.

160 consecutive patients aged 42 to 92 (mean, 70) years underwent 185 cementless THAs for primary osteoarthritis or femoral neck fractures. All procedures were performed by a single surgeon using the same modular, cementless, proximally hydroxyapatite-coated, anatomic femoral stem, regardless of age and bone quality. Clinical evaluation (pain, range of movement, and ability to walk) was based on the Merle d'Aubigne and Postel scores. Radiological assessment was based on criteria by Engh et al. in the 7 Gruen zones with regard to the presence of radiolucent lines, osteolysis, cancellous condensation, cortical hypertrophy or atrophy, reactive lines, and pedestal formation. Failure of the stem was defined as revision or impending revision because of aseptic loosening or pain.

Results.

Of the 160 patients, 21 died and none were lost to follow-up. In 3 of the 21 patients, the femoral stems were revised for periprosthetic fractures after a fall at 6 weeks, 10 months, and 3.8 years. 138 patients (162 THAs) completed a mean follow-up of 7.8 (range, 5.5–10.4) years. Their overall mean Merle d'Aubigne and Postel scores increased from 7.09 preoperatively to 16.36 postoperatively. The mean Engh score was 24.9 out of 27, with the mean score for femoral stem fixation 10 out of 10 and 14.9 out of 17 for femoral stem stability. No reactive lines at the bone-stem interfaces and no subsidence or osteolysis were evident in any of the radiographs. There were 5 periprosthetic femoral fractures, 2 deep infections, 3 dislocations, and 2 aseptic loosening (one each for the femoral stem and acetabular socket). Survivorship of the femoral stem at 10 years was 99% when revision secondary to only aseptic loosening of the stem was the endpoint. It was 96% when failures due to all causes (infection, periprosthetic fracture, and aseptic loosening) were the endpoints.

Conclusion.

The MBA femoral prosthesis provides a predictably stable fixation, with excellent mid-term outcome.
Radiographic Assessment of the Safe Zone for Medial Oblique Opening Wedge High Tibial Osteotomy
Authors: Siripisitsak Thana , Vanadurongwan Bavornrat , Harnroongroj Thos , Harnroongroj Thossart
Published: October 2016

Purpose.

To compare different cephalocaudal angles of the X-ray beam in measuring internal rotation of the proximal tibia that best demonstrates the safe zone.

Methods.

10 pairs of embalmed, disarticulated knee joints from 10 cadavers were used. Soft tissues around the proximal tibia and the proximal tibiofibular joint (PTFJ) were dissected to reveal the articular cartilage. A narrow area between the end of the articular cartilage of the posterolateral proximal tibia and of the PTFJ was identified as the safe zone with a U-shape metal used as a radiographic marker. Translation of the proximal tibia was controlled during internal rotation of the proximal tibia. Internal rotation of the proximal tibia that best demonstrated the safe zone (the U-shape metal at its most outermost point) was measured at 0°, 5°, 10°, 15°, 20°, and 25° cephalocaudal angles of the X-ray beam.

Results.

The mean internal rotation of the proximal tibia that best demonstrated the safe zone at 0°, 5°, 10°, 15°, 20°, and 25° cephalocaudal angle of the X-ray beam were 50°, 45°, 37°, 32°, 23°, and 19°, respectively.

Conclusion.

The safe zone was best demonstrated with 50° and 45° internal rotation of the proximal tibia at 0° and 5° cephalocaudal angles of the X-ray beam, respectively.
Non-Contrast Magnetic Resonance Imaging for Diagnosing Shoulder Injuries
Authors: Arnold Heino
Published: October 2016

Purpose.

To compare preoperative non-contrast magnetic resonance imaging (MRI) with arthroscopy findings in diagnosing labral and rotator cuff tears.

Methods.

86 men and 60 women aged 21 to 70 (mean, 52) years underwent non-contrast MRI before arthroscopic operations on the glenohumeral joint. Slices were made in a transvese, parasagittal, and paracoronar orientation. The sequences used were T2- and proton-weighted for paracoronar imaging, T1- and T2-weighted for transverse and parasagittal imaging, and T2-weigthed sequences with fat suppression and short tau inversion recovery sequences. MRI was evaluated with the surgeon to eliminate interobserver bias. Arthroscopic surgery was performed by a single surgeon. If a labral or rotator cuff tear was found, surgery was performed using corkscrew anchors.

Results.

For full thickness rotator cuff tears, MRI and arthroscopy detected them in 76 and 82 patients, respectively. One such tear found by MRI could not be confirmed by arthroscopy. MRI missed 4 subscapularis and 3 supraspinatus tears. The sensitivity and specificity of MRI in diagnosing full thickness rotator cuff tears were 0.90 and 0.91, respectively. For labral tears, MRI and arthroscopy detected them in 16 and 31 patients, respectively. One anterior labral tear detected by MRI could not be verified by arthroscopy. All 16 labral tears detected by MRI were Bankart type-I tears (of the anterior glenoid) except for one superior labral tear from anterior to posterior (SLAP tear). All 13 SLAP tears (10 type 2 and 3 type 3) except for one could be found by arthroscopy only. The sensitivity and specificity of MRI in diagnosing labral tears were 0.52 and 0.89, respectively.

Conclusion.

Non-contrast MRI is reliable only for diagnosing full thickness rotator cuff tears and anterior labral tears. Direct or indirect contrast enhancement is recommended for more differentiation. Special scan orientation is necessary for SLAP tears.
Total Wrist Arthroplasty Using the Universal 2 Prosthesis
Authors: Morapudi Syam PK , Marlow William J , Withers Daniel , Ralte Peter , Gabr Ayman , Waseem Mohammad
Published: October 2016

Purpose.

To report outcomes of 21 total wrist arthroplasties (TWA) using the Universal 2 prosthesis.

Methods.

Five men and 14 women aged 44 to 82 (mean, 62) years underwent 21 total wrist arthroplasties for rheumatoid arthritis (n=19) and post-traumatic arthritis (n=2) by a single surgeon using the Universal 2 prosthesis. Pre- and post-operative pain and function were assessed by a single surgeon using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the patient-rated wrist evaluation (PRWE) score. Range of motion, stability, dislocation rate, and neurovascular status were also assessed. Radiographs were evaluated for implant alignment and fit, screw positioning, and implant loosening.

Results.

The mean time to assessment of the range of motion was 3.1 (range, 1.8–3.9) years, and the mean time to assessment of the PRWE score was 4.8 (range, 2.1–7.3) years. The range of motion in each direction and the mean DASH and PRWE scores improved significantly following TWA. Two patients had restricted range of motion, which was treated by manipulation under anaesthetic (after 6 months in one and 8 weeks in the other). One patient underwent excision of a palmar bony bridge. One patient endured extensor pollicis longus rupture and underwent tendon transfer after 5 months. Radiographs revealed no evidence of implant loosening, migration, or malalignment. There was no sign of osteonecrosis in the remaining carpals or metacarpals.

Conclusion.

The Universal 2 TWA achieved significant improvement in range of motion and functional outcome of the wrist, with reduced rates of early joint instability, dislocation, and implant loosening, compared to previous implants. The small implant size and cementless design reduce bone loss and osteonecrosis.
C-Reactive Protein and Interleukin-6 Levels in the Early Detection of Infection after Open Fractures
Authors: Douraiswami Balaji , Dilip Patro K , Harish BN , Jagdish Menon
Published: October 2016

Purpose.

To measure C-reactive protein (CRP) and interleukin-6 (IL-6) levels in 30 patients with open fractures and correlate the levels with infection.

Methods.

29 men and one woman aged 9 to 70 (mean, 37) years presented with open fractures of the upper or lower extremity within 12 hours of injury and underwent debridement and external fixation 3 to 40 (mean, 16) hours after injury. Serum CRP and IL-6 concentrations were measured preoperatively and on postoperative days 2 and 4. CRP was measured using latex agglutination and nephelometry, and IL-6 by enzyme-linked immunosorbent assay. The mean CRP and IL-6 levels in infected and non-infected patients were compared. The trend of CRP and IL-6 levels within the infected group was analysed. Correlations between CRP and infection, and between IL-6 and infection were analysed.

Results.

11 of the 30 patients developed wound infection. The day-2 CRP levels of 30 patients were positive (range, 7–28 μg/ml). In 27 patients, the CRP levels were higher on day 2 than preoperation. On day 4, CRP levels declined sharply in patients without infection (mean, 8 μg/ml) but were persistently elevated in patients with infection (mean, 17 μg/ml). The sensitivity and specificity of the CRP test were 100% and 42%, respectively. In the 11 patients with infection, the IL-6 concentrations were elevated at day 2 (mean, 689 pg/ml) and decreased progressively at day 4 (mean, 175 pg/ml). The sensitivity and specificity of the IL-6 test were 90% and 100%, respectively. Infection correlated with CRP and IL-6 levels.

Conclusions.

Serial serum measurements of IL-6 and CRP levels help in the early diagnosis of infections after open fractures before they are clinically evident.
Spontaneous Spinal Epidural Haematoma after Antiplatelet Treatment: A Report of Two Cases
Authors: Wang Lushun , Liu Gabriel , Subramaniam Sivashankar , Wong Thomas Aloysius Kah Wai , Kumar Naresh
Published: October 2016

We report 2 cases of spontaneous spinal epidural haematoma after antiplatelet treatment. One patient was on ticlodipine therapy and the other was on aspirin and clopidogrel. Both diagnoses were made using magnetic resonance imaging. One patient underwent multilevel laminectomies and posterior spinal fusion within 24 hours of symptom onset and achieved complete neurological recovery. The other underwent unilateral hemilaminectomies 40 hours after symptom onset and did not show neurological improvement. A high index of suspicion is needed for patients presenting with severe lower back pain and rapid neurological deterioration, especially in those on antiplatelet therapy. Urgent spinal cord decompression and epidural haematoma cord evacuation may provide more favourable outcome.
Traumatic Atlanto-Occipital Dislocation: A Case Report
Authors: Munoz-Mahamud Ernesto , Combalia Andres , Bori Guillem
Published: October 2016

We report a 30-year-old man with atlanto-occipital dislocation after a traffic accident. Diagnosis was based on radiography, computed tomography, and magnetic resonance imaging. Owing to the critical conditions that did not fulfil advanced trauma and life support protocols, surgical treatment was deferred, and the patient died 10 hours later.
Distal Fibular Lengthening after Premature Growth Arrest: A Case Report
Authors: Manoudis Grigorios N , Kontogeorgakos Vasileios A , Badras Leonidas S
Published: October 2016

Post-traumatic premature closure of the distal fibular growth plate is a rare entity leading to shortening of the lateral malleolus. We report on a 14-year old boy who presented with a 4-year history of worsening, diffuse discomfort and swelling of his left ankle, as well as fibular shortening and talar malreduction. He had sustained a distal tibial fracture 4 years earlier and had been treated with closed reduction. He reported instability of the ankle and difficulty with running. There was 1-cm shortening of the left fibula, 1-cm shortening of the proximal fibula, and slight widening of the medial clear space. Both tibial and fibular growth plates were already closed and the left ankle joint space was slightly narrowed. He was treated with late fibular lengthening and autogenous iliac crest tricortical bone grafting and achieved anatomic restoration of the distal tibiofibular relationship. At one-year follow-up, the ankle-hindfoot score had improved from 69 to 100.
Medium-Term Outcome of Mosaicplasty for Grade III-IV Cartilage Defects of the Knee
Authors: Reverte-Vinaixa Maria Mercedes , Joshi Nayana , Díaz-Ferreiro Eugenio Wenceslao , Teixidor-Serra Jordi , Domínguez-Oronoz Rosa
Published: October 2016

Purpose.

To evaluate the medium-term outcome of mosaicplasty for full-thickness cartilage defects of the knee joint in 17 patients.

Methods.

Records of 12 men and 5 women aged 16 to 57 (mean, 35) years who underwent mosaicplasty for grade III/IV osteochondral defects in the lateral (n=14) or medial (n=3) femoral condyle were reviewed. 12 of the patients had undergone knee surgeries. The mean size of the defects was 3.4 (range, 1–4) cm2. Three patients had defects of >2 cm2. All operations were performed by a single surgeon using mini-arthrotomy. The lateral edge of the trochlea was the donor site. Graft integration and the presence of any abnormality at the articular surface were assessed using magnetic resonance imaging (MRI). In addition, patients were evaluated using the International Knee Documentation Committee (IKDC) rating scale, the SF-36 health questionnaire, visual analogue scale (VAS) score for pain.

Results.

Two of the 17 patients developed necrosis and cystic degeneration of the grafts and underwent conversion to unicompartmental knee arthroplasty within 2 years. They were older than 45 years and had defects of >2 cm2. Respectively in years 4 and 7, one and 4 patients were lost to follow-up, the mean IKDC score was 75% and 88%, the SF-36 score was 83% and 90%, and the VAS score was ≤3 in 13 of 14 patients at year 4 and in all 11 patients at year 7. At the 7-year follow-up, patient satisfaction with mosaicplasty was excellent in 8 patients, good in 3, and poor in 2 (who underwent unicompartmental knee arthroplasty). At year 4, MRI showed integration of the cartilage repair tissue and incorporation of the osseous portion of the graft into the bone in 13 of the 14 patients. The remaining patient had osteoarthritis at the graft donor site. At year 7, MRI showed good integration of the implant in all 11 available patients, but fissures were seen on the cartilage surface in 3 patients.

Conclusion.

The medium-term outcome of autologous mosaicplasty for symptomatic osteochondral defects in the femoral condyle is good. Longer follow-up is needed to determine the structural and functional integrity of the graft over time.
Simultaneous Bilateral Total Knee Replacement: A Prospective Study of 150 Patients
Authors: Jain Sanjeev , Wasnik Sandeep , Mittal Amber , Sohoni Sameep , Kasture Sarang
Published: October 2016

Purpose.

To evaluate the safety of simultaneous bilateral total knee replacement (TKR).

Methods.

124 women and 26 men (mean age, 66 years) underwent simultaneous bilateral TKR for tricompartmental osteoarthritis using a posterior-stabilised, high-flexion implant. All patients underwent dobutamine stress echocardiography for detection of any silent cardiac comorbidity by a cardiologist. None had any adverse effect after testing. Five patients had positive outcome and underwent coronary angiography to detect any significant coronary blockage. Functional outcome was evaluated using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Tranexamic acid was given intravenously to reduce peri-operative blood loss. Femoral blocks and patient-controlled analgesia were used to facilitate early recovery. Aggressive physiotherapy was allowed. Patients were followed up at months 3, 6, and 12, and yearly thereafter.

Results.

At the 2-year follow-up, the mean range of motion improved from 95° to 129° (p=0.032), the mean KSS from 120 to 158 (p<0.001), and the WOMAC from 51 to 88 (p=0.002). One patient developed patellar crepitus at week 6, which resolved with conservative treatment. Another patient developed infection in both knees at month 6. Despite salvage procedures, infection recurred after 3 months and the patient underwent bilateral arthrodesis. No patient developed deep vein thrombosis or pulmonary embolism, myocardial infarction, atrial fibrillation, or other cardiac event.

Conclusion.

Simultaneous bilateral TKR is safe for properly selected patients.
Reliability of Two-Dimensional Computed Tomography for Measuring Hip Anatomy
Authors: Boyle Matthew J , Yassaie Omid , Grieve Philip P , Frampton Christopher MA
Published: October 2016

Purpose.

To evaluate the reliability (inter- and intra-observer variability) of 4 hip anatomies using 2-dimensional pelvic computed tomography (CT).

Methods.

Two-dimensional pelvic CT of 10 men and 10 women aged 33 to 89 (mean, 69) years presenting with non-orthopaedic conditions within one month were evaluated by 3 observers. The centre-edge angle of Wiberg, the Sharp angle, the acetabular depth ratio of Murray, and the acetabular anteversion angle of every hip were measured by each observer. After 6 weeks, these measurements were repeated. Reliability was evaluated using intraclass correlation coefficient (ICC), which represents the variation between patients as a percentage of the variation from all 3 sources (patients, inter-observers, and intra-observers). The ICC was classified as poor (<0.20), fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80), and excellent (0.81–1.00).

Results.

Reliability was substantial for the Sharp angle (ICC=0.74), the acetabular anteversion angle (ICC=0.69), and the acetabular depth ratio of Murray (ICC=0.62), and was fair for the centre-edge angle of Wiberg (ICC=0.40).

Conclusion.

The Sharp angle, the acetabular anteversion angle, and the acetabular depth ratio of Murray could be reliably measured using 2-dimensional CT. These measurements are appropriate for population-based studies of hip anatomy.
Tibiotalocalcaneal Arthrodesis in a Singaporean Hospital
Authors: Tan Bryan Yijia , Ng Sean Yung Chuan , Chong Keen Wai , Rikhraj Inderjeet Singh
Published: October 2016

Purpose.

To report 18 patients who underwent tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail or cannulated screws.

Methods.

10 men and 8 women (19 ankles) aged 36 to 70 (mean, 52) years underwent tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail (n=13) or cannulated screws (n=6). Indications for arthrodesis were severe cavovarus deformity secondary to polio or charcot-marie-tooth disease (n=7), severe osteoarthritis in the ankle and subtalar joints (n=6), Charcot joint deformity (n=3), failed fusion procedures (n=2), and foot drop secondary to T12 tumour surgery (n=1). The visual analogue score (VAS) for pain was assessed, as were the American Orthopaedic Foot and Ankle Society (AOFAS) scores (for subjective and objective pain, function, and stability of the ankle), short form 36 (SF-36), and patient expectation and satisfaction scores.

Results.

The mean follow-up period was 35.6 (range, 11–144) months. 13 of 18 patients returned for assessment of scores. 18 of the 19 ankles achieved fusion after a mean period of 5.9 (range, 3–11) months. The mean VAS scores for pain, AOFAS scores, and SF-36 scores all improved. 11 patients had good-to-excellent satisfaction and expectation scores. Two patients had severe wound infections and underwent implant removal (after bone union), debridement, and intravenous antibiotic therapy. Two other patients had superficial wound infections. One patient with retrograde intramedullary nailing had a pseudoarthrosis and underwent implant removal, redebridement, re-autografting, and cannulated screw fixation. Fusion was achieved subsequently.

Conclusion.

Tibiotalocalcaneal arthrodesis improved the pain score and quality of life, despite a high risk of complications.
Percutaneous Autologous Bone Marrow Injections for Delayed or Non-Union of Bones
Authors: Singh Ashok K , Shetty Sanat , Saraswathy Jayadeep J , Sinha Amit
Published: October 2016

Purpose.

To evaluate 12 patients with delayed or nonunion of bones treated with bone marrow injections.

Methods.

6 men and 6 women aged 15 to 70 (mean, 45) years underwent bone marrow injections for delayed union (n=2) or atrophic non-union (n=10) of the ulna (n=6), femur (n=3), humerus (n=2), or metacarpal (n=1). Bone marrow was aspirated from the anterior iliac crest and injected to the delayed and non-union sites. Two injections were given for children and adolescents, and 3 for adults. The interval between the injections was 6 to 8 weeks. The amount of bone marrow injected was 30 to 40 ml for long bones and 20 ml for metacarpals.

Results.

Ten of the 12 delayed or non-union of bones healed after bone marrow injections. The mean time for callus formation was 5.8 (range, 3–10) weeks, for clinical union was 7 (range, 4–12) weeks, and for radiological union was 16 (range, 10–24) weeks.

Conclusion.

Multiple injections of low-volume bone marrow can be used for treatment of delayed or nonunion of bones.
Prevention of Knot Slippage with the Use of Cyanoacrylate Glue: A Mechanical Study
Authors: Smith George H , McEachan JE , McLean A , Huntley JS
Published: October 2016

Purpose.

To assess the effect of cyanoacrylate glue on knot slippage and strength in vitro.

Methods.

Ethibond 3/0 was tested using a tensile tester. A single drop of cyanoacrylate glue was applied to the knots. Seven knot configurations (10 samples each) were tested: (1) a surgeon's knot (S) plus 4 square throws (+4) without glue (control group), (2) S plus one square throw (+1) without glue, (3) S+1 with glue, (4) S with glue, (5) S+1 wet post-tie without glue, (6) S+1 wet pre-tie without glue, and (7) S+1 wet pre-tie with glue. Wet sutures were immersed in normal saline for 24 hours prior to knot tying. Wet pre- and post-tie sutures were immersed for one minute prior to knot tying and tensile testing, respectively. Outcome measures were the mode of failure (knot slippage or suture snapping) and the ultimate tensile strength.

Results.

All knots without glue failed owing to knot slippage, except for the controls, whereas all knots with glue failed owing to suture snapping. The ultimate tensile strength was significantly higher in knots with glue and controls than in knots without glue. The ultimate tensile strength did not differ significantly between S+4 without glue and S with glue (p=0.48), indicating that glue could reinforce knots and reduce the number of throws needed. Wet suture is protective against failure (p<0.01).

Conclusion.

Cyanocrylate glue may have clinical applications for flexor tendon repairs for which a reduced knot size is advantageous.
Prevalence of Insomnia in Patients with Chronic Back Pain
Authors: Purushothaman Balaji , Singh Anjani , Lingutla Kiran , Bhatia Chandra , Pollock Raymond , Krishna Manoj
Published: October 2016

Purpose.

To estimate the prevalence of insomnia in patients with chronic back pain, and to correlate insomnia with severity of back pain and disability.

Methods.

63 women and 57 men aged 24 to 83 (mean, 55) years who presented with chronic back pain for >6 months were asked to complete a self-administered questionnaire to evaluate the Insomnia Severity Index (ISI), Oswestry Disability Index (ODI), and Numerical Rating Scale (NRS) for back pain.

Results.

Of the 120 patients, 25 had no insomnia, 39 had sub-threshold insomnia, and 56 had clinically significant insomnia. According to the ODI, disability was minimal in 12 patients, moderate in 38, severe in 43, bed-binding in 26, and crippling in one. Of the 120 patients, 91 rated their NRS for back pain as 5 to 10 and 29 rated it as 1 to 4. Correlation was stronger between ISI and ODI than between ISI and NRS for back pain ( r=0.59 vs. r=0.38).

Conclusion.

47% of patients with chronic back pain had insomnia. The ODI was more reliable than the NRS for back pain to detect insomnia. Back pain should be treated early to avoid serious health problems associated with insomnia.
Mortality and Re-Operation Rate after Proximal Femoral Fracture Surgery by Trainees
Authors: Khunda Aiman , Jafari Maya , Alazzawi Sulaiman , Mountain Alistair , Hui Anthony CW
Published: October 2016

Purpose.

To review records of 761 patients who underwent surgery for proximal femoral fractures to determine whether surgeon's experience and volume was associated with 6-month mortality and reoperation rates.

Methods.

Records of 761 patients who underwent surgery for proximal femoral fractures were reviewed. Patients operated on by a consultant or trainees with supervision of a scrubbed consultant were classified as the consultant group (n=214). Patients operated on by trainees alone (n=516) or trainees with supervision of an unscrubbed consultant (n=31) were classified as the trainee group (n=547). A total of 21 trainees were identified. They had different levels of experience, which was quantified according to the total number of operations performed for proximal femoral fractures from the start of their training to the start of the study.

Results.

Patients in the trainee group were older (80±12 vs. 77±14 years, p<0.001), and the fractures were more complex in the consultant group. The 6-month mortality rate was 24.2% (n=184). The odds of dying within 6 months after operation was 80% higher in patients operated on by trainees without supervision of a scrubbed consultant (odds ratio, 1.8; 95% confidence interval, 1.1–2.7). Variables associated with the 6-month mortality rate were age (p<0.001), American Society of Anesthesiologists grade (p<0.001), pre-injury activity level (p<0.001), and the surgeon's grade (p<0.05). The 6-month reoperation rate was 3.8% (n=29) and did not differ significantly in the 2 groups. The experience level of the trainees was not associated with the 6-month reoperation rate.

Conclusion.

The odds of dying within 6 months after a surgery for proximal femoral fractures was 80% higher in patients operated on by trainees without supervision of a scrubbed consultant.
Accuracy of Core Needle Biopsy for Musculoskeletal Tumours
Authors: Seng Chusheng , Png Wenxian , Tan Mann Hong
Published: October 2016

Purpose.

To evaluate the sensitivity and specificity of core needle biopsy in determining musculoskeletal tumours in our hospital.

Methods.

Records of 134 patients who underwent core needle biopsy followed by definitive surgery were retrospectively reviewed. Results of the core needle biopsy were compared with those of the final histology. Histology was classified into benign versus malignant, and bony versus soft-tissue lesions. The sensitivity and specificity of core needle biopsy were calculated.

Results.

Based on final histology, there were 33 bone tumours (3 benign and 30 malignant), 74 soft-tissue tumours (6 benign and 68 malignant), 11 schwannomas (7 benign and 4 malignant), and 16 inflammatory/necrotic (benign) lesions. For 118 (88%) tumours, the biopsy results matched the final histological results. For 7 tumours, biopsy results were non-diagnostic, as the amount of tissue obtained was insufficient. For 9 tumours, biopsy results did not match the final histological results; 5 considered benign but turned out to be malignant, one considered malignant but turned out to be benign, and 3 were correctly identified as malignant but incorrectly subtyped. The sensitivity and specificity of core needle biopsy were 95% (97/102) and 97% (31/32), respectively, assuming that the 7 non-diagnostic tumours were correctly diagnosed.

Conclusion.

Core needle biopsy is an accurate and reliable diagnostic tool for musculoskeletal tumours if performed by skilled persons and adequate tissue is obtained.
Insufficiency Fracture of the Proximal Fibula and Then Tibia: A Case Report
Authors: Cheung Man Hong Steve , Lee Man-Fai , Lui Tun Hing
Published: October 2016

Elderly people with osteoarthritis of the knee and postpartum women are at risk of insufficiency fractures of the proximal fibular or tibia. We report on an 82-year-old woman with valgus osteoarthritis of the knee who developed insufficiency fractures of the right proximal fibula and then the right proximal tibia. She underwent total knee arthroplasty using a long tibial stem and a tibial locking plate with the Less Invasive Stabilization System.
Notching of the Femoral Stem Neck in Metal-on-Metal Total Hip Replacement: A Case Report
Authors: Leung Ka-Hei , Chiu Kwong-Yuen , Ng Fu-Yuen , Yin Li
Published: October 2016

We report a case of impingement in a metal-on-metal total hip replacement causing both notching of the femoral stem neck and aseptic loosening of the acetabular component. The acetabular component was inserted in excessive anteversion. The femoral stem and acetabular components were retrieved. A larger femoral head was used, and an acetabular component was placed in a less anteverted position. Intra-operative testing through different ranges of movement is recommended to identify potential impingement.
Comparison of Different Warfarin Reversal Protocols on Surgical Delay and Complication Rate in Hip Fracture Patients
Authors: Leonidou Andreas , Rallan Rishi , Cox Nancy , Pagkalos Joseph , Luscombe Jonathan
Published: October 2016

Purpose.

To compare the effects of different warfarin reversal protocols on surgical delay and complication rate in hip fracture patients.

Methods.

Records of 7 men and 17 women aged 68 to 93 (mean, 82) years who were on warfarin and underwent surgery for femoral neck fractures were reviewed. The time to surgery, complication rate, and mortality were recorded, as were the International Normalised Ratio (INR) on admission and the day of operation, as well as the dose, route, and time of administration of vitamin K for reversing the anticoagulation effect of warfarin. Patients were divided into 4 groups based on the warfarin reversal treatment. Group 1 (n=4) included patients who did not receive reversal treatment, as their admission INR was ≤1.5. Group 2 (n=6) included patients who did not receive reversal treatment even though their INR was >1.6. Group 3 (n=5) included patients who received inappropriate reversal treatment (late or low-dose oral administration). Group 4 (n=9) included patients who received appropriate reversal treatment in terms of dose, route, and time of administration.

Results.

Among the 4 groups, the mean INR was 2.2 (range, 1.3–4.6) on admission and 1.4 (range, 1.0–1.6) on the day of surgery. Group 1 was excluded from further analysis. Respectively in groups 2, 3, and 4, the mean times to surgery were 2.3, 2.6, and 1.2 days, and the complication rates were 67%, 20%, and 11%.

Conclusion.

Early administration of intravenous vitamin K for hip fracture patients on warfarin is recommended to ensure early operative management and avoid postoperative complications.
Withholding Clopidogrel for 3 to 6 versus 7 Days or More before Surgery in Hip Fracture Patients
Authors: Khudairy Ammar Al , Al-Hadeedi O , Sayana MK , Galvin R , Quinlan John F
Published: October 2016

Purpose.

To compare morbidity and mortality after hip fracture surgery in patients withholding clopidogrel for 3 to 6 days versus ≥7 days.

Methods.

Records of 16 men and 31 women aged 49 to 92 (mean, 80.2) years who underwent hip fracture surgery after withholding clopidogrel for 3 to 6 days (n=24) versus ≥7 days (n=23) were compared. The patients were taking clopidogrel owing to ischaemic heart disease (n=37), cerebrovascular disease (n=7), and intolerance to aspirin (n=3). Patient demographics, American Society of Anesthesiologists status, preoperative delay, length of hospital stay, perioperative haemoglobin reduction, receipt of blood and platelet transfusions, morbidity, and mortality were recorded.

Results.

Respectively in the early-surgery and delayed-surgery groups, the mean surgical delay was 4.2 and 8.0 days, the mean length of hospital stay was 21.1 and 28.7 days, the mean peri-operative haemoglobin reduction was 1.5 and 1.1 g/dl, the mean units of blood transfusion per patient was 0.8 and 0.7. No severe intra-operative bleeding or wound haematoma was encountered in either group. Two patients in each group died within one month, and 2 more in the delayed-surgery group died within 3 months. The main cause of death was cardiovascular.

Conclusion.

Withholding clopidogrel for <7 days before surgery conferred no increased risk in hip fracture patients.
Effect of Calcium Triphosphate Cement on Proximal Humeral Fracture Osteosynthesis: A Cadaveric Biomechanical Study
Authors: Kennedy Jim , Molony Diarmuid , Burke Neil G , FitzPatrick David , Mullett Hannan
Published: October 2016

Purpose.

To evaluate the effect of filling a central humeral bone void with calcium triphosphate cement on the strength and stability of an osteosynthesis in elderly cadavers.

Methods.

14 fresh cadaveric shoulder specimens obtained from 11 donors (mean age, 91.5 years; mean body weight, 61 kg) were divided into 2 age- and sex-matched groups. A standardised 3-part proximal humeral fracture with a central bone void was created in each specimen. Each specimen was reduced and fixed with a locking plate. In half the specimens the central bone void was packed with calcium triphosphate cement. The intra-fragmentary motion and the load and mode of failure were recorded.

Results.

Respectively in the test group and controls, the intra-fragmentary motion was 1.0 and 6.4 mm, and the peak displacement at the 500 N load was 1.8 and 9.1 mm. The Cohen's d was 1.6 to 2.7 for all load steps, indicating a large effect of the calcium triphosphate cement on strength and stability. The mean difference in the failure load was 300 N (p<0.05).

Conclusion.

Construct stability and failure load improved significantly when the central humeral bone void was filled with calcium triphosphate cement.