bluuebunny/crossref_metadata_2025 huggingface dataset:
Sacral Insufficiency Fractures
Authors: Schindler OS , Watura R , Cobby M
Published: October 2016

Purpose.

To highlight difficulties in the diagnostic process and the validity of imaging techniques for sacral insufficiency fractures.

Methods.

Records of 25 women aged 68 to 95 years with sacral insufficiency fractures were reviewed. Baseline blood biochemistry and haematology test results were obtained. Pelvic anterior/posterior radiography was undertaken for all patients; additional computed tomography, technetium bone scanning, and magnetic resonance imaging were used in some. Treatments were based on the severity of the injury and the patient's mobility and cooperativeness.

Results.

Among the 25 women, 11 had bilateral and 14 had unilateral vertical sacral fractures. Associated fractures included horizontal sacral fracture, fractures of the os pubis and ilium. Symptoms included lower back or buttock pain, abdominal pain, and those emulating radiculopathy and myelopathy, including leg weakness, sciatica, and urinary retention. The mean delay in diagnosis was 9 (range, 1–28) days. The mean recovery time between bilateral and unilateral fractures was significantly different (22 [range, 12–33] vs 14 [range, 8–36] weeks, p=0.01). No patient with bilateral fractures regained her pre-injury mobility, compared to 43% among those with unilateral fractures (p=0.02, Fisher's exact test). Computed tomography was the most reliable imaging technique; technetium bone scanning was highly sensitive but non-specific; magnetic resonance images of the fractures may mimic metastatic disease.

Conclusion.

With the increase in the elderly population, sacral insufficiency fractures may become epidemic in future. Primary and secondary osteoporoses are common causes. Once a diagnosis is established, in most cases treatment is simple but recovery may be protracted and full mobility curtailed.
Nocardia Nova Septic Arthritis following Total Knee Replacement: A Case Report
Authors: Nizam I , Kohan L , Kerr D
Published: October 2016

We describe a case of Nocardia nova septic arthritis following a total knee replacement. A 55-year-old obese woman was admitted to hospital 5 months after knee surgery with a 3-week history of pain, swelling, and restricted mobility in her left knee but no preceding trauma/injury. 30 ml of cloudy joint fluid was aspirated and an arthroscopic examination showed extensive fibrin formation and synovitis. An arthroscopic washout was carried out using 16 litres of saline, followed by total synovectomy and intensive antibiotic therapy (clarithromycin 500 mg twice daily and co-trimoxazole [sulphamethoxazole 400 mg and trimethoprim 80 mg] once daily and augmentin duo forte 875 mg twice daily). At 2.5 years, the patient had recovered completely with no prosthetic loosening.
Dynamic Hip Screw and Compression Plate Fixation of Ipsilateral Femoral Neck and Shaft Fractures
Authors: Abalo A , Dossim A , Bangna AF Ouro , Tomta K , Assiobo A , Walla A
Published: October 2016

Purpose.

To evaluate surgical outcomes of ipsilateral femoral neck and shaft fractures.

Methods.

Between April 1997 and September 2004, 29 men and 8 women (mean age, 37 years) underwent fixation of femoral neck and shaft fractures using a dynamic compression plate plus a dynamic hip screw or screws. There were 30 femoral neck and 7 pertrochanteric fractures. Functional results were assessed according to the Friedman and Wyman classification.

Results.

The mean follow-up period was 49 months. Of the femoral neck fractures, 34 united in a mean of 4 months; 33 of them healed anatomically and one with a 6° varus angulation. No osteonecrosis of the femoral head was noted. Of the femoral shaft fractures, 32 united in a mean of 6 months, 5 were non-unions (2 persisted even after revision surgery). Seven patients developed infections (5 superficial and 2 deep), which resolved with debridement and antibiotic treatment. Functional results were good in 29 patients, fair in 5, and poor in 3.

Conclusion.

The use of dynamic hip screws and compression plates for ipsilateral femoral neck and shaft fractures is reliable in achieving bone union with few complications.
Anthropometry of the Patellar Tendon in Chinese
Authors: Luk KMS , Wong NM , Cheng JCK
Published: October 2016

Purpose.

To assess the length of the patellar tendon in Chinese and its correlation with patient age, gender, and operated side.

Methods.

109 men and 11 women aged 15 to 45 (mean, 25) years underwent arthroscopic bone-tendon-bone reconstruction for anterior cruciate ligament (ACL) insufficiency. 55 (46%) injured the left side, and 65 (54%) the right side. Each patient's age, gender, and operated side were recorded. The length of the patellar tendon harvested was measured.

Results.

The mean length of the patellar tendon graft was 42.6 (standard deviation, 4.6; range, 30–54) mm. There was no correlation between the length of the patellar tendon and patient's age (p=0.147), gender (p=0.076), or operated side (p=0.466).

Conclusion.

The length of the patellar tendon in the Chinese is comparable to that in Caucasians. Because of the shorter ACL but similar patellar tendon length, graft-tunnel mismatch may be more common in Chinese than Caucasian patients.
Septic Arthritis in Haemodialysis Patients: A Seven-Year Multi-Centre Review
Authors: Al-Nammari SS , Gulati V , Patel R , Bejjanki N , Wright M
Published: October 2016

Purpose.

To determine relevant demographics, clinical features, and outcomes for septic arthritis in patients on haemodialysis for end-stage renal failure.

Methods.

A multi-centre retrospective review was performed from 1999 to 2005.

Results.

15 cases were identified. The mean age of the patients at diagnosis was 67 (range, 23–89) years and 11 were male. All had multiple co-morbidities and additional risk factors for sepsis. The primary sources of sepsis were dialysis access–related (n=12), unknown in 2, and unrelated soft tissue infection in one. All patients presented with acute mono-articular symptoms; the knee joint was affected in 11 patients. The white cell count, neutrophil count, and C-reactive protein concentration were elevated in 10, 10, and 15 patients, respectively. All patients had positive synovial fluid cultures and blood cultures were positive in 14. Organisms isolated were all skin commensals, being staphylococcal in 13 and streptococcal in 2. Six patients had concomitant rheumatological disease (gout in 4, pseudogout in one, and rheumatoid arthritis in one). Two had urate crystals in the synovial fluid (noted by microscopy). All patients underwent antimicrobial therapy for a mean of 36 days, together with joint washouts and debridement. 12 patients were cured of infection; 2 developed chronic sepsis secondary to localised osteomyelitis; and one died of sepsis.

Conclusion.

Septic arthritis is a potentially devastating condition. Early and aggressive joint lavage and debridement combined with appropriate antimicrobial therapy is imperative. A high index of suspicion is necessary in haemodialysis patients; the diagnosis of septic arthritis must be presumed until proven otherwise.
Composite Ceramic Bone Graft Substitute in the Treatment of Locally Aggressive Benign Bone Tumours
Authors: Schindler OS , Cannon SR , Briggs TWR , Blunn GW
Published: October 2016

Purpose.

To report the use of a composite ceramic bone graft substitute containing calcium sulphate and hydroxyapatite (HA) in the treatment of large expansive osteolytic benign bone tumours.

Methods.

4 women and 9 men aged 8 to 49 (mean, 22) years with aneurysmal bone cysts (n=6) or giant cell tumours (n=7) in the epi- or meta-physeal areas of the lower limbs underwent curettage, phenolisation, and filling with bone graft substitute containing calcium sulphate and HA. The mean tumour size was 38.5 (range, 18–65) ml. The patients were followed up for a mean of 41 (range, 33–52) months. Range of movement, Musculoskeletal Tumor Society Rating Score (MTSRS), and haematological and blood biochemical parameters were measured.

Results.

Two patients had recurrence at 7 and 9 months, both progressed to grade-III giant cell tumours. One underwent revision with an iliac crest autograft, whereas the other underwent en bloc excision and prosthetic replacement. The 11 other lesions displayed clinical and radiological consolidation at a mean of 4.6 (range, 3–7) months. No restriction of range of movement was observed, except in the patient undergoing prosthetic replacement. The mean MTSRS was 96% (range, 83–100%) of that expected for normal function. During the follow-up period, haematological and blood biochemical parameters stayed within normal limits.

Conclusion.

Composite bioceramic osteoconductive grafts, which combine porous HA with calcium sulphate, provide a framework for human osteogenesis and avoid donor-site morbidity (autologous bone graft harvesting). Tumour recurrence remains a major concern especially in young patients, as revision invariably requires removal of additional bone, potentially compromising joint integrity.
Preoperative Embolisation in Benign Bone Tumour Excision
Authors: Lee VN , Nithyananth M , Cherian VM , Amritanand R , Venkatesh K , Sundararaj GD , Raghuram LN
Published: October 2016

Purpose.

To assess the role of preoperative embolisation in benign bone tumour excision.

Methods.

3 men and 3 women aged 19 to 35 (mean 23) years with either a giant cell tumour or an aneurysmal bone cyst in limb girdle sites underwent preoperative embolisation a day prior to wide local excision by the same surgeon. Tumour size, blood loss, wound healing, infection, and tumour recurrence were assessed.

Results.

The mean total blood loss was 391 (range, 100–980) ml. No blood transfusion was needed. No patient had any surgery- or embolisation-associated complication. No tumour recurred within a minimum 5-year follow-up. All patients had satisfactory limb function.

Conclusion.

Preoperative embolisation is useful in the management of vascular and aggressive bone tumours located at limb girdle sites where a tourniquet cannot be used.
Needle Aponeurotomy for Dupuytren's Contracture
Authors: Cheng HS , Hung LK , Tse WL , Ho PC
Published: October 2016

Purpose.

To review the efficacy and safety of needle aponeurotomy for Dupuytren's contracture in Chinese patients.

Methods.

Seven men and one woman aged 50 to 80 (mean, 67) years underwent needle aponeurotomy for Dupuytren's contracture. Five were manual workers and the other 3 were retired. Their chief complaints were difficulty moving the fingers, clumsiness of the hand, and occasional pain in the palm. No patient had any family history of Dupuytren's contracture.

Results.

41 points were released in 13 fingers (3 middle, 3 ring, and 7 little). Immediately after release, the respective mean flexion contracture correction of the metacarpophalangeal and proximal interphalangeal joints were 50 (from 50 to 0) and 35 (from 46 to 11) degrees. At 22-month follow-up, the respective mean residual flexion contracture of both joints were 12 and 27 degrees; the corresponding long-term improvements were 70 and 41%. No patient had a wound complication or neurovascular injury. All had a normal score for Disabilities of the Arm, Shoulder, and Hand.

Conclusion.

For Chinese patients with Dupuytren's contracture, needle aponeurotomy is safe and effective. Long-term correction is better maintained in metacarpophalangeal than proximal interphalangeal joints (70 vs 41%).
Correction Osteotomy for Malunion of the Talar Head: A Case Report
Authors: Matsumura T , Sekiya H , Hoshino Y
Published: October 2016

Talar head fractures are rare injuries. We present a 26-year-old man with malunion of the talar head. The displaced fracture was initially neglected. The patient was treated with osteotomy and bone grafting to improve the congruity and movement of the talonavicular joint. Three months after surgery, he returned to his pre-injury activity level with no disability.
Bilateral Knee Lipoma Arborescens: A Case Report
Authors: Yan CH , Wong JWK , Yip DKH
Published: October 2016

A 45-year-old Chinese man presented with recurrent bilateral knee swelling and pain. He was initially diagnosed with gouty arthritis, but later found to have lipoma arborescens. Magnetic resonance imaging demonstrated frond-like proliferations of fatty synovium. Arthroscopic synovectomy was performed. Histological examination of the specimen revealed villiform fatty tissue covered by slightly thickened synovium characteristic of lipoma arborescens. Magnetic resonance imaging is useful in differentiating lipoma arborescens from other intra-articular lesions in patients with recurrent knee pain and swelling.
Posterolateral Elbow Dislocation with Ipsilateral Radial and Ulnar Diaphyseal Fractures: A Case Report
Authors: Kose O , Durakbasa MO , Islam NC
Published: October 2016

Elbow dislocation associated with both ipsilateral radial and ulnar shaft fractures is a rare pattern of injury, although it is common for elbow dislocation and forearm fractures to occur separately. We report a case of an 80-year-old woman who had a posterolateral elbow dislocation and ipsilateral radial and ulnar shaft fractures and underwent closed reduction and plate fixation. She had an excellent outcome after 22 months of follow-up.
Twin Hook Fixation for Proximal Femoral Fractures
Authors: Hagino T , Ochiai S , Wako M , Sato E , Maekawa S , Hamada Y
Published: October 2016

Purpose.

To report results of twin hook fixation for proximal femoral fractures in comparison to those fixed with the conventional lag screw.

Methods.

Between August 2005 and July 2006, 2 men and 15 women aged 74 to 94 (mean, 85) years with proximal femoral fractures underwent open reduction and internal fixation using the twin hook system. The tip-apex distance was compared with that in 20 patients treated with the sliding hip screw between August 2004 and July 2005.

Results.

In the 17 patients, the hook was inserted into the centre of the femoral head. Bone union was achieved and no intra- or post-operative cut-out or device failure was encountered. In patients using the twin hook and sliding hip screw respectively, the mean tip-apex distance was 22.3 mm and 14.6 mm (p<0.001).

Conclusion.

Using the twin hook system requires more surgical skill than using the sliding hip screw, because failure to insert the pin into the centre of the femoral head risks intra-articular perforation by the hooks.
V Osteotomy and Ilizarov Technique for Residual Idiopathic or Neurogenic Clubfeet
Authors: Segev E , Ezra E , Yaniv M , Wientroub S , Hemo Y
Published: October 2016

Purpose.

To report the treatment outcomes of V osteotomy and Ilizarov technique for residual idiopathic or neurogenic clubfeet.

Methods.

13 patients (14 feet) aged 8 to 18 years underwent V osteotomy via the calcaneus and talus, followed by gradual distraction of soft tissue and bone for foot reconstruction. Eight of the clubfeet were idiopathic and had undergone previous surgeries. The remaining 6 were neurogenic and their pathologies were: Charcot-Marie-Tooth disease (n=2), myelomeningocele (n=2), neurofibromatosis (n=1), and distal arthrogryposis (n=1). Three of them had undergone previous surgeries. The Ilizarov frames were retained for 3 to 6 months and the patients were followed up for 1.8 to 8.9 years. Range of movement of the ankle and foot, appearance and position, gait, pain, function, and patient satisfaction were assessed according to the modified clubfoot grading system. The talo-1st metatarsal angle was measured on anteroposterior radiographs.

Results.

Scores associated with the appearance and position of the foot, and thus patient satisfaction were significantly improved, but not for range of movement, pain, and function. The mean preoperative and final talo-1st metatarsal angles were 39.7 and 8.7 degrees, respectively (p<0.01). Ten feet achieved the plantigrade position, one had residual equinus, and 3 had residual adduction and supination.

Conclusion.

Patient satisfaction improved significantly despite no major improvement in pain, function, and range of movement of the ankle and foot. This reflects the importance of the appearance and position of the foot, and justifies the decision to undergo this long and demanding procedure.
Autologous versus Pooled Human Serum for Articular Chondrocyte Growth
Authors: Munirah S , Ruszymah BHI , Samsudin OC , Badrul AHMY , Azmi B , Aminuddin BS
Published: October 2016

Purpose.

To evaluate the effect of autologous human serum (AHS) versus pooled human serum (PHS) versus foetal bovine serum (FBS) for growth of articular chondrocytes and formation of chondrocyte-fibrin constructs.

Methods.

Experiments with monolayer culture expansion of human articular chondrocytes were performed using basic culture media supplemented with 10% AHS, PHS, or FBS. Growth kinetics and specific phenotypic expression of the serially expanded chondrocytes were evaluated. Large-scale culture expansion was used to obtain about 30 million cells to form chondrocyte-fibrin constructs. All constructs were implanted subcutaneously at the dorsum part of athymic nude mice for 8 weeks. The in vivo constructs were evaluated using histological and gene expression studies.

Results.

The morphology of primary cultured chondrocytes (P0) was polygonal and became more elongated and larger after serial passages (P1, P2, and P3). This was comparable for AHS, PHS, and FBS. Total cell yields accumulated for AHS (28 million) and PHS (41 million) were significantly higher than those for FBS (4 million). After 8 weeks of implantation, in vivo chondrocyte-fibrin constructs demonstrated a glistening white and firm texture, comparable to normal hyaline cartilage. All constructs exhibited histo-architectural characteristics of well-distributed cartilage-isolated cells embedded within basophilic ground substance. Presence of accumulated proteoglycans cartilage-rich matrix was indicated by positive orange-red Safranin O staining. During monolayer culture expansion, collagen type II gene expression was down-regulated, while collagen type I gene expression was up-regulated. Collagen type II—the specific chondrogenesis marker—was re-expressed in the in vivo chondrocyte-fibrin construct.

Conclusion.

AHS and PHS are better than FBS for in vitro cultivation of human articular chondrocytes.
Autologous Chondrocyte Transplantation in the Repair of Full-Thickness Focal Cartilage Damage in Rabbits
Authors: Kamarul T , Selvaratnam L , Masjuddin T , Ab-Rahim S , Ng C , Chan KY , Ahmad TS
Published: October 2016

Purpose.

To compare the efficacy of autologous chondrocyte transplantation (ACT) versus non-operative measures for cartilage repair in rabbits.

Methods.

Nine New Zealand white rabbits were used. Identical focal defects were created in the articular cartilage of both knees. One month later, the right knee was repaired via ACT, while the left knee was left untreated (control group). The quality of cartilage tissues in both knees was compared 3 months later, according to the quantitative analysis of glycosaminoglycan (GAG) in the cartilage and macroscopic examination of histology using the Brittberg/International Cartilage Research Society (ICRS) score.

Results.

Microscopic examination showed enhanced regeneration following ACT repair. Quantification analysis revealed significantly higher cellular expression of GAG in the ACT-treated knees (1.12 vs 0.81 μg GAGs/mg protein, p=0.008). The mean Brittberg/ICRS score was significantly higher in the treated knees (6.00 vs 1.89, p=0.007).

Conclusion.

ACT is superior to non-operative measures for repairing focal cartilage defects, as determined by favourable histological and immunohistological outcomes at the cellular level.
Brachial Artery Aneurysm Rupture in a Patient with Neurofibromatosis: A Case Report
Authors: Jeong WK , Park SW , Lee SH , Kim CW
Published: October 2016

Peripheral vascular manifestations of neurofibromatosis are rare but may result in fatal haemorrhaging when they rupture. Surgeons should be aware of this life-threatening condition. We report a case of 35-year-old woman with neurofibromatosis who presented with a swollen and tender mass around her right arm. Angiography revealed 2 aneurysms in the brachial artery. Surgical occlusion revealed a large amount of clotted blood within the subfascial space, and the bleeding point was identified as a pinpoint opening in the aneurysm. The brachial artery abutting the aneurysm and the surrounding soft tissues was extremely brittle and fragile, with massive oozing during dissection. The brachial artery was irreparable and was resected after ligation of the artery and surrounding soft tissues and the aneurysm. Despite an uneventful recovery, the patient died on day 4.
Morphologic Differences of the Distal Femur between Caucasian and Japanese Women
Authors: Urabe K , Mahoney OM , Mabuchi K , Itoman M
Published: October 2016

Purpose.

To compare the morphology of the distal femur between Caucasian and Japanese women.

Methods.

30 Caucasian women aged 41 to 84 (mean, 67) years and 70 Japanese women aged 54 to 86 (mean, 70) years who underwent total knee arthroplasty for osteoarthritis were randomly selected. Morphologic measurements of the distal femur were compared using lateral radiographs. Both race and height influenced the morphology. To adjust for the influence of height on morphology, each measurement was divided by the patient's height and the ratios were compared.

Results.

Caucasian women were generally taller and heavier (p<0.001) and had higher body mass index (p=0.03) than the Japanese women. Each morphologic measurement of the distal femur was significantly longer in the Caucasian women. In both groups, anteroposterior width of the condyle correlated more with height than weight. In women of equal height, the anteroposterior and metaphyseal widths of the femur and the anterior and resected condyles were longer in Caucasian women, but the posterior condyle was longer in Japanese women.

Conclusion.

Both the size of the femur and the anterior and posterior condyles are significantly larger in Caucasian than Japanese women.
Inter- and Intra-Observer Errors in Identifying the Transepicondylar Axis and Whiteside's Line
Authors: Yan CH , Yau WP , Ng TP , Lie WH , Chiu KY , Tang WM
Published: October 2016

Purpose.

To assess inter- and intra-observer errors in identifying the transepicondylar axis and Whiteside's line in a cadaveric model mimicking total knee arthroplasty.

Methods.

Four cadaveric knees with intact soft tissues were used. The knees were exposed anteriorly using the Insall approach, with the patella everted laterally. Three observers (2 surgeons and one trainee) took turns to identify the anatomic landmarks of the transepicondylar axis and Whiteside's line. Each observer repeated the process 20 times. Each identification was photographed and referenced with the true values obtained from the knees after they were stripped of all soft tissue. Inter- and intra-observer errors in the anatomic landmarks were compared.

Results.

Inter-observer error was significant with both the transepicondylar axis and Whiteside's line (p<0.001, one-way ANOVA). The intra-observer variation was greater for Whiteside's line than the transepicondylar axis (standard deviation, 4.2° vs 2.5°). The maximum potential errors in the transepicondylar axis and Whiteside's line were 13° and 24°, respectively.

Conclusion.

The accuracy of rotational alignment of the transepicondylar axis and Whiteside's line were operator-dependent, and their intra-operative reproducibility was low.
Prosthesis Design and Stress Profile after Hip Resurfacing: A Finite Element Analysis
Authors: Heijink A , Zobitz ME , Nuyts R , Morrey BF , An KN
Published: October 2016

Purpose.

To evaluate the effect of prosthesis design on stress profile in the proximal femur after hip resurfacing.

Methods.

The von Mises stress profile of the native femur was simulated and compared with that of resurfaced femurs using various prosthetic materials (titanium, cobalt-chrome, ceramic), stem lengths (normal, half, short, and no stem), and femoral head coverage (shell size) [260°, 220°, 180°, and 140°].

Results.

Hip resurfacing altered the stress profile of the cancellous (but not cortical) bone of the femoral neck. Maximal cortical stresses were observed at the posterior half of the medial femoral neck. The stress profile of the native femur was most similar to that of the resurfaced femur made of titanium, with a short or no stem and 260 degrees of femoral head coverage (shell size). Conclusion. Optimising prosthesis design by minimising biomechanical alterations seems a valid approach to achieving favourable long-term outcomes. Cadaveric and in vivo studies are needed to confirm the clinical relevance and feasibility.
Review Article: Approach-Related Complications of Open versus Thoracoscopic Anterior Exposures of the Thoracic Spine
Authors: Cheung KMC , Ghazi S Al
Published: October 2016

This article reviews the approach-related complications of open versus thoracoscopic anterior exposures of the thoracic spine and suggests possible ways to avoid them.
Philos Plate Fixation for Displaced Proximal Humeral Fractures
Authors: Fazal MA , Haddad FS
Published: October 2016

Purpose.

To evaluate the treatment outcome of Philos plate fixation for displaced proximal humeral fractures in 27 consecutive patients.

Methods.

6 men and 21 women aged 22 to 85 (mean, 56) years underwent Philos plate fixation for displaced proximal humeral fractures. 11 patients were aged ≤60 years and 16 >60 years. All fractures were closed with no associated injuries and classified as 2-part (n=13), 3-part (n=12), and 4-part (n=2), according to the Neer classification. Patients were assessed radiologically and functionally using the Constant shoulder score.

Results.

Patients were followed up for 6 to 24 (mean, 13) months. All the fractures united except in a 76-year-old woman with a 3-part fracture in whom there was fracture collapse and screw penetration of the humeral head at 6 weeks. She subsequently developed non-union and avascular necrosis. The mean Constant shoulder score was 70 (range, 28–88). 11 patients had a score exceeding 75, 13 were scored between 50 and 75, and 3 were below 50.

Conclusion.

Philos plate fixation provided stable fixation, minimal metal work problems and enabled early range-of-motion exercises to achieve acceptable functional results.
Ligamentotaxis for Barton's and Paediatric Distal Radial Fractures
Authors: Lakshmanan P , Sayana MK , Purushothaman B , Sher JL
Published: October 2016

Purpose.

To establish a consensus regarding immobilisation of the wrist following reduction of Barton's and paediatric distal radial fractures.

Methods.

Questionnaires were distributed to orthopaedic surgeons at the European Federation of National Associations of Orthopaedics and Traumatology meeting in Lisbon in 2005. Questions included the surgeon's country of practice, hospital, professional grade, years of experience, sub-specialty, and preferred position of wrist immobilisation after (1) a volar Barton's fracture, (2) a dorsal Barton's fracture, (3) a paediatric Salter-Harris type-II injury to the distal radius with volar displacement, and (4) the same injury but with dorsal displacement.

Results.

Of 148 questionnaires distributed, 118 were returned. The specialist-to-trainee ratio was 45:73. In volar Barton's fractures, only 20% (29% specialists and 15% trainees) would immobilise the wrist in palmar flexion, as per recommendations. In dorsal Barton's fractures, only 25% (33% specialists and 21% trainees) would immobilise the wrist in dorsiflexion, as per recommendation. In paediatric Salter Harris type-II injury to the distal radius with volar displacement, 87% (100% specialists and 79% trainees) would immobilise the wrist in dorsiflexion or in a neutral position, as per recommendation. In the same injury but with dorsal displacement, 84% (89% specialists and 81% trainees) would immobilise the wrist in palmar flexion or in a neutral position, as per recommendation. In all 4 types of fractures, 26% to 30% of respondents would immobilise the wrist in a neutral position.

Conclusion.

Most respondents deviate from the recommended immobilisation positions in treating Barton's fractures. Understanding of the anatomy or biomechanics of ligamentotaxis are crucial for conservative treatments.
Facet Cyst Haematoma in the Lumbar Spine: A Report of Four Cases
Authors: Miyatake N , Aizawa T , Hyodo H , Sasaki H , Kusakabe T , Sato T
Published: October 2016

We present 4 cases of facet cyst haematoma in the ligamentum flavum of the lumbar spine. All patients presented with a one-to-3-month history of back pain or numbness in the legs, and sudden neurological deterioration. One also developed cauda equina syndrome and another developed radiculopathy. In all cases, magnetic resonance imaging showed a mass with high signal intensity on both T1- and T2-weighted images. Facet arthrography and computed tomography revealed communication between the mass and the neighbouring facet joint. The haematomas were removed en bloc with the ligamentum flavum. They were surrounded by the ligament and contained degenerated and lacerated elastic fibres but no synovial lining cells. Facet cyst haematoma is so-named because of bleeding from tissue adjacent to the facet joint into a pre-existing facet cyst.
Infectious Arthritis of the Knee Caused by Mycobacterium Terrae: A Case Report
Authors: Milne BW , Arnold MH , Hudson B , Coolican MRJ
Published: October 2016

Mycobacterium terrae is ubiquitous in our environment. M terrae infections most commonly involve tendon sheaths, bones, bursae, and joints. We report a case of infectious arthritis of the knee caused by M terrae in a 21-year-old man who had non-specific chronic synovitis. No organism was seen on microscopy or isolated from cultures until months later. Initially the M terrae culture was considered a contaminant and specific anti-mycobacterial treatment was not advised. The patient was commenced on suppressive therapy for persistent effusion and discomfort. Eventually, the M terrae infection was confirmed and he was commenced on clarithromycin, ciprofloxacin, and ethambutol. The triple antibiotic regimen was continued for 2 years. The knee improved but never completely settled. The patient chose to cease all antibiotic medication. The knee remained swollen and irritable, with little chance of eradicating the organism.
Traumatic Dislocations of the Proximal Tibiofibular Joint: A Report of Two Cases
Authors: Sreesobh KV , Cherian J
Published: October 2016

Traumatic dislocations of the proximal tibiofibular joint are rare and difficult to diagnose. They can present as an isolated case or in association with multiple injuries. They are typically classified into subluxation, anterolateral, posteromedial, and superior dislocations. We report 2 unusual dislocations (posterolateral and inferior) of the proximal tibiofibular joint, both associated with floating knee injuries. Their diagnoses are mainly based on the presence of neurovascular injuries.
Reconstruction of the Achilles Tendon and Overlying Soft Tissue Using an Anteromedial Thigh Flap for a Post-Burn Pes Equinus Deformity: A Case Report
Authors: Naganawa T , Ohno Y , Ohnishi K , Shimizu K
Published: October 2016

We present a 36-year-old man with a severe pes equinus deformity of the ankle and an intractable ulcer over the Achilles tendon after a 4th-degree burn. He underwent a one-stage reconstructive surgical procedure using an anteromedial thigh flap with its vascularised fascia. After lengthening of the Achilles tendon and posterior release of the ankle, the anteromedial thigh fasciocutaneous flap was transferred. The ischaemic Achilles tendon was wrapped with the vascularised femoral fascia for vascularisation and reinforcement. The skin defect was covered with the skin paddle of the combined flap. There were no postoperative complications. At the 3-year follow up, the range of movement of the ankle was almost normal. The patient was able to walk and climb stairs without support, and the ulcer was cured.
Comparison of Fibroblast Survival in Freeze-Dried Irradiated Platelets, Fresh Concentrated Platelets, or Foetal Bovine Serum
Authors: Ruangchainikom Monchai , Waikakul Saranatra , Wongkajornsilp Adisak , Chongkolwatana Viroje
Published: October 2016

Purpose.

To compare the survival of human fibroblasts in freeze-dried irradiated platelets, fresh concentrated platelets, or foetal bovine serum.

Methods.

3, 10, 30, and 100 μg protein/ml of freeze-dried irradiated platelets or fresh concentrated platelets, or 5%, 15%, and 50% of foetal bovine serum were each added to the culture medium with human fibroblasts. Controls had no growth factors or serum added. The initial number of fibroblasts was 5000 per well plate. After 72 hours of incubation, the number of living fibroblasts was measured using the MTT (dimethylthiazol diphenyl tetrazolium bromide) assay. Inter- and intra-group differences were compared.

Results.

After 72 hours of incubation, the number of living fibroblasts was highest in wells with foetal bovine serum, followed by fresh concentrated platelets, freeze-dried irradiated platelets, and controls. Inter-group differences between the controls and each of the other groups were significant. Intra-group differences were significant for all subgroups with fresh concentrated platelets (except 30 vs 100 μg) and foetal bovine serum.

Conclusion.

Freeze-dried irradiated platelets contain enough growth factor activity for fibroblast survival and may be used to promote wound healing.
Ligamentum Flavum Haematoma: A Report of Two Cases
Authors: Takahashi Hiroshi , Wada Akihito , Yokoyama Yuichirou , Fukushi Shinichirou , Sakurai Tatsuro , Shibuya Kazutoshi , Suguro Toru
Published: October 2016

We present 2 cases of ligamentum flavum haematoma causing root compression. Magnetic resonance imaging showed an epidural mass linked to the ligamentum flavum. The mass was isointense in T1-weighted images, and was centrally hyperintense and peripherally hypointense in T2-weighted images. Surgical removal of the ligamentum flavum achieved resolution of the symptoms. The definitive diagnosis could only be confirmed by histopathological examinations. The differential diagnoses include lumbar disc herniation and lumbar spinal canal stenosis caused by neoplasm, infection, epidural haematoma, or facet cyst.
Laminar Fractures as a Severity Marker in Burst Fractures of the Thoracolumbar Spine
Authors: Tisot Rodrigo A , Avanzi Osmar
Published: October 2016

Purpose.

To assess the correlation between the presence of lamina fractures, narrowing of the spinal canal, and the severity of injury.

Methods.

Records of 146 men and 44 women aged 13 to 84 (mean, 39) years diagnosed with burst fractures of the thoracolumbar spine were retrospectively reviewed. The laminar fractures and narrowing of the spinal canal were measured using computed tomography. The severity of injury was determined using the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). The ISS and NISS of patients with and without laminar fractures were compared. The sensitivity and specificity of ISS, NISS, and narrowing of the spinal canal in association with laminar fractures were also compared.

Results.

92 (48%) of the patients had laminar fractures. The mean narrowing of the spinal canal was more severe in patients with laminar fractures than those without (47% vs 28%, p<0.001). Patients with laminar fractures had a significantly higher mean ISS (17 vs 12, p<0.001) and NISS (19 vs 13, p<0.001). Narrowing of the spinal canal is more sensitive and specific than the ISS and NISS when correlating laminar fractures.

Conclusion.

In patients with burst fractures of the thoracolumbar spine, the presence of laminar fractures indicates a more severe injury.
Laminoplasty after Anterior Spinal Fusion for Cervical Spondylotic Myelopathy
Authors: Pang Chun-Hong , Leung Hon-Bong , Yen Chi-Hung
Published: October 2016

Purpose.

To review outcomes of laminoplasty after anterior spinal fusion (ASF) in 8 patients with cervical spondylotic myelopathy (CSM).

Methods.

Records of 3 men and 5 women aged 49 to 80 (mean, 60) years who underwent laminoplasty after ASF for CSM were reviewed. Before and after ASF and laminoplasty, the causes of CSM, mechanical instability, the Pavlov Torg ratio, the numbers of levels of stenosis, myelomalacia, ASF, and laminoplasty, the modified Japanese Orthopaedic Association (JOA) score, and the Hirabayashi recovery rate were recorded in all the patients.

Results.

After ASF, the mean modified JOA score improved to 9.6 from 8.3 (p=0.05), with a mean Hirabayashi recovery rate of 12.5% at the 12-month follow-up. However, it deteriorated to 9 after a mean of 25 (range, 3–54) months follow-up. Indications for a secondary laminoplasty included inadequate decompression (n=5), progression of prolapsed discs (n=4), osteophytes (n=3), ossification of the posterior longitudinal ligament (n=1), and hypertrophy of the ligamentum flavum (n=4). The mean interval between ASF and laminoplasty was 30 (range, 14–55) months. The mean number of levels of laminoplasty was 4.5 (range, 4–5). After laminoplasty, all patients had adequate spinal decompression with no cord compromise, neck pain or stiffness, despite the signal change remaining the same. Two patients improved, 2 deteriorated, and 4 remained unchanged with respect to walking status. The mean modified JOA scores improved to 9.7 from 9 (p=0.38); the mean Hirabayashi recovery rate was −1.5%. All patients had persistent myelomalacia, which was not reflected in the improved modified JOA score.

Conclusions.

Initial surgery (such as ASF) is more effective in relieving cord compromise and myelopathy. Inadequate decompression and progression of disease may necessitate secondary laminoplasty, which conferred additional benefits that 5 of our 8 patients enjoyed despite persistence of myelomalacia.
Outcome of Osteoplastic Laminotomy for Excision of Spinal Cord Tumours
Authors: Matsumoto Yoshihiro , Harimaya Katsumi , Doi Toshio , Maeda Takeshi , Iwamoto Yukihide
Published: October 2016

Purpose.

To evaluate the outcome of osteoplastic laminotomy after excision of primary tumours of the thoracolumbar and lumbar spine.

Methods.

Records of 10 male and 11 female consecutive patients aged 15 to 57 (mean, 37) years who underwent osteoplastic laminotomy for excision of spinal cord tumours in the thoracolumbar (n=13) and lumbar (n=8) spine were reviewed. After tumour resection, the removed posterior elements were reattached to the superior and inferior processes using anchoring sutures. Pre- and postoperative functional status was retrospectively graded according to the modified McCormick scale. Spinal deformities were classified as sagittal and coronal malalignment, segmental instability, and spondylolisthesis.

Results.

The mean follow-up duration was 43 (range, 12–108) months. The mean number of laminae excised was 1.3 (range, 1–4). At the final follow-up, the modified McCormick scale score improved in 16 patients, remained unchanged in 4, and deteriorated in one. No patient developed any severe complication, recurrence, spondylolisthesis, or aseptic necrosis of grafted laminae. In 2 patients their spinal deformities became worse: one had segmental instability of 17° at L3–4 secondary to non-union of the L3 lamina; the other (with type-I neurofibromatosis and dystrophic deformity) underwent fusion for severe low back pain and lumbar kyphosis and progressive rotational dislocation, despite union of the grafted L2 lamina.

Conclusions.

Osteoplastic laminotomy preserves the structures that could be important for spinal stability and may reduce the risk of deformities. Anterior strut grafting and posterior fusion may be necessary in neurofibromatosis patients with dystrophic deformities.
Surgical Outcome of Soft Tissue Sarcomas of the Adductor Compartment
Authors: Rudiger Hannes A , Ngan Samuel YK , Choong Peter FM
Published: October 2016

Purpose.

To review outcomes and complications of 25 consecutive patients with soft tissue sarcomas in the adductor compartment.

Methods.

Records of 11 men and 14 women aged 20 to 83 (mean, 56) years who underwent resection for soft tissue sarcomas in the adductor compartment were reviewed. Two of the patients had undergone inadequate resection of the tumour elsewhere. No patient had metastases. 20 and 2 patients underwent neo-adjuvant and postoperative radiotherapy, respectively. The interval between radiotherapy and surgery was at least 3 weeks. No neo-adjuvant chemotherapy was given. 24 patients underwent limb salvage surgery and one had external hemipelvectomy. 21 patients had direct wound closure; in 4 a microsurgical free flap was used.

Results.

The overall survival rate was 81% and 72% at 3 and 5 years, respectively, and remained unchanged until the end of follow-up. Four patients died from pulmonary metastases and one died from liver metastases. One patient had local recurrence, and 7 (26%) developed major complications. Five patients underwent revision surgery.

Conclusion.

Good survival and local control rates can be achieved in patients with soft tissue sarcomas in the adductor compartment using limb salvage and radiotherapy.
Combined Preoperative Autologous Blood Donation and Intra-Operative Cell Salvage for Hip Surgery
Authors: Kubota Reiko , Nozawa Masahiko , Matsuda Keiji , Maezawa Katsuhiko , Kim Sung-Gon , Maeda Kouichi , Ikegami Takashi , Hayashi Kentarou , Nagayama Masataka , Kaneko Haruka
Published: October 2016

Purpose.

To review records of 161 consecutive hip surgery patients for whom preoperative autologous blood donation (PABD) was used in combination with intra-operative cell salvage (ICS).

Methods.

114 women and 14 men aged 41 to 86 (mean, 64) years underwent 135 primary total hip arthroplasties (THAs), whereas 19 women and 7 men aged 16 to 52 (mean, 35) years underwent 26 rotational acetabular osteotomies (RAOs). Two or 3 weeks before the operation, patients deposited one unit (400 ml) of blood weekly, so long as their haemoglobin levels exceeded 110 g/1 (if they had osteoarthritis) or 100 g/1 (if they had rheumatoid arthritis). Patients were given oral ferrous sulphate, lactated Ringer's solution, and recombinant human erythropoietin. 800 and 1200 ml of blood were deposited for patients undergoing THA and RAO, respectively. Intra-operatively, ICS was carried out using a continuous autotransfusion system. The blood from ICS was transfused first, and then the blood from PABD was transfused during the latter half of the operation.

Results.

By combining PABD and ICS, homologous blood transfusion was avoided in all patients, even in those with unexpected massive bleeding during surgery. In 3 patients, one unit of deposited autologous blood was discarded, because they showed no sign of anaemia. The mean total blood loss was almost 1.5 times higher in RAO than in THA patients (1095 vs 1550 ml). In the THA and RAO patients respectively, the mean amount of ICS was 181 and 210 ml, whereas the mean total blood transfusion volume was 975 and 1394 ml. No complications (including infection) related to autologous blood transfusion were observed during PABD, the surgery or the postoperative period.

Conclusion.

Homologous blood transfusion was avoided with the use of PABD and ICS. Preoperative donation of 800 and 1200 ml of blood (combined with ICS) seemed optimal, as only 3 units of blood were discarded.
Terrible Triad of the Elbow
Authors: Seijas Roberto , Ares-Rodriguez Oscar , Orellana Adolfo , Albareda Daniel , Collado Diego , Llusa Manel
Published: October 2016

Purpose.

To review epidemiological characteristics and treatment outcomes of the terrible triad of the elbow.

Methods.

Records of 18 cases of the terrible triad of the elbow occurring in 8 women and 8 men aged 17 to 77 (mean, 45) years were reviewed. The epidemiology and various treatment approaches and functional outcomes were recorded. The mean follow-up period was 13.6 (range, 4–38) months. The injury mechanisms included simple falls (n=12), falls from a low height (n=2), traffic accidents (n=2), and sports accidents (n=2). Radial head fractures and the coronoid apophysis fractures were classified.

Results.

There were 10 type-III and 8 type-II radial head fractures, 9 type-I and 9 type-II coronoid apophysis fractures, and all humeroulnar dislocations were posterior. The mean duration of immobilisation was 25.5 (range, 17–38) days. After rehabilitation, the mean range of motion of the elbow improved to 130° flexion (24% recovery), 18° extension (35% recovery), 73° supination (142% recovery), and 85° pronation (25% recovery). The greatest gain in range of motion occurred within 3 to 4 months. Complications included heterotopic ossification (n=4), blocked pronation and supination (n=4), transient ulnar nerve injury (n=2), Essex-Lopresti lesion (n=2), unnoticed dislocation (n=3), and rapidly progressive arthrosis (n=1).

Conclusion.

Although our patients had better recovery of range of motion than those reported in other studies, the terrible triad of the elbow can lead to joint instability, osteoarthritis, arthrosis, and joint stiffness, and may resort to total elbow arthroplasty in some cases.
Early Adolescent Nutritional Rickets
Authors: Agarwal Anil , Gulati Divesh
Published: October 2016

Purpose.

To evaluate early adolescents with nutritional rickets and their responses to treatment.

Methods.

203 adolescents (aged 10 to 13 years) presenting with clinical features of lower-limb deformity, carpopedal spasm, joint swelling, a significant limp, or non-traumatic joint pain were screened for nutritional rickets. Multi-specialty examinations were performed. Family size, number of earning members, number and gender of children, preference for vegetarian food, composition of the meals, and the amount of milk consumed in a day were recorded. Radiographs of wrists, knees, ankles, and pelvis, as well as serum calcium, phosphate, and alkaline phosphatase levels were evaluated. The diagnosis of nutritional rickets was made based on a combination of clinical, radiological, and biochemical criteria, and confirmed by the responses to treatment. Children with nutritional rickets were treated by a single large intramuscular dose of vitamin D (600 000 IU) along with oral calcium and supplementary vitamin D as well as advice on diet and sunlight exposure.

Results.

40 females and 11 males were diagnosed as having nutritional rickets. 65% presented with bilateral knee pain with aggravation at night, 37% presented with lower-limb deformity, 24% had joint swelling especially at the wrist and ankle, 6% had a significant limp and walked with an antalgic gait secondary to pathological fractures. No patient reported carpo-pedal spasm. All patients had rachitic changes on radiographs in some but not all bones (100% in the ulna, 45% in the radius, 37% in the upper tibia, 37% in the lower fibula and 22% in the lower tibia). Three patients had pathological fractures. 55% had hypocalcaemia, 41% had hypophosphataemia and 100% had raised serum alkaline phosphatase levels. The mean time for biochemical resolution was 12 (range, 3–24) weeks. For radiological resolution it was 5 (range, 2–6) months, with the lower end of ulna being last to resolve.

Conclusions.

Radiographs of the lower end of ulna and serum alkaline phosphatase levels can be used as a screening and monitoring tool for nutritional rickets in early adolescents. There may be a high prevalence of subclinical vitamin-D deficiency in our adolescent population.