bluuebunny/crossref_metadata_2025 huggingface dataset:
Cross-Linked Polyethylene and Bisphosphonate Therapy for Osteolysis in Total Hip Arthroplasty: A Case Report
Authors: O'Hara LJ , Nivbrant B , Röhrl S
Published: October 2016

A 39-year-old woman underwent bilateral total hip arthroplasty with conventional, ethylene oxide–sterilised liners when she was a subject in a radiostereometric analysis study. Within 2 years she had rapid polyethylene wear with aggressive, asymptomatic, and periprosthetic osteolysis on both sides. Oral alendronate therapy halted the progression of osteolysis over a year and revision to cross-linked polyethylene liners was then undertaken while one stem was curettaged and the other revised. Radiostereometric analysis revealed a 96% reduction in wear rate over 2 years with the cross-linked liners. On stopping alendronate treatment, aggressive osteolysis recurred on the curretaged but not on the revised femur.
Operative Treatment of Hip Fracture in Haemodialysed Patients
Authors: Sano K , Ito K , Inahata Y , Ueno T , Kou A , Kimura T , Imakiire A
Published: October 2016

Purpose.

To study operative treatment and postoperative clinical outcomes of hip fracture in haemodialysed patients.

Methods.

In 12 patients (8 men and 4 women) undergoing haemodialysis, 14 hip fractures were treated. Of these, 8 hips were treated with bipolar hip arthroplasty, one hip with total hip arthroplasty, 4 hips with a compression hip screw, and one hip with a gamma nail. The mean duration of dialysis treatment until fracture was 7 years. During a mean postoperative follow-up period of 17 months (range, 1–44 months), the patients' renal condition, type of fracture, and level of activities of daily living before and after surgery were assessed.

Results.

Of the 7 patients who died during a mean follow-up period of 17 months, 2 died from myocardial infarction, 2 from sepsis, and one each from gastric cancer, pulmonary oedema, and liver failure. Five of the 8 patients with diabetic nephropathy died, whereas 6 of the 8 patients who underwent bipolar hip arthroplasty or total hip arthroplasty died. Most of the patients had declined level of activities of daily living postoperatively.

Conclusion.

For haemodialysed patients with fractures, it is essential to select the most suitable operating method and to conduct vigilant management before and after the operation.
Detection of High-Energy Phosphates in Cortical Bone as an Indicator of Bone Healing and Remodelling: Use of a Rabbit Model
Authors: Buchholz J , Huber FX , Meeder PJ , Muhr G , Kreitz GK , Herzog L
Published: October 2016

Purpose.

To study high-energy phosphates in cortical bone through experiments on inbred white New Zealand rabbits.

Methods.

Tibial fractures were induced in 80 rabbits and then stabilised by screw osteosynthesis. After 3 (group A; n=40) or 7 days (groups B; n=40), the defective tissue was covered by local muscle flaps. At increasing intervals (from 1 to 16 weeks), the screws were removed and the animals were euthanised (n=8 per group). The bone was removed and analysed histomorphologically; adenosine triphosphate (ATP) levels were determined by high-performance liquid chromatography.

Results.

The mean ATP concentration in healthy cortical bone at 16 weeks was 0.092 (standard error, 0.009) nmol/mg dry mass, which was significantly higher than that in the group with delayed healing: 0.081 (0.011) nmol/mg in group A and 0.005 (0.001) nmol/mg in group B (paired t test, p<0.05). Earlier healing led to lower rates of necrosis (0 vs 38; groups A vs B) and osteomyelitis.

Conclusion.

Early muscle-flap coverage can revascularise the cortical bone, which is reflected in the higher ATP content in the cortical bone measured by high-performance liquid chromatography. Measuring changes of ATP levels can help investigate the metabolism of the pathological bone.
Tennis Elbow—Outcome following the Garden Procedure: A Retrospective Study
Authors: Kumar VS , Shetty AA , Ravikumar KJ , Fordyce MJF
Published: October 2016

Purpose.

From 1993 to 1999, 17 patients (18 elbows) underwent the Garden procedure for clinically diagnosed tennis elbow. Non-operative treatment was ineffective for these patients.

Methods.

The study group consisted of 10 men and 7 women, with a mean age of 49.6 years. Follow-up duration ranged from 18 months to 6 years, with a mean of 37 months. Patients' pain, activity level, and hand grip strength were evaluated postoperatively.

Results.

14 (77.8%) elbows had an excellent or good result, 2 elbows had a fair result, and another 2 elbows had a poor result and required revision surgery. Most patients had immediate relief of elbow pain, returned to work early, and did not notice any weakness of hand grip strength or radial wrist extension. There were no significant complications.

Conclusion.

The Garden procedure produced good results for tennis elbow with minimal morbidity in an unselected group of patients. This retrospective study supports the view that the underlying lesion in tennis elbow is in the origin of extensor carpi radialis brevis.
Squamous Cell Carcinoma of the Nail Bed: Three Case Reports
Authors: Wong TC , Ip FK , Wu WC
Published: October 2016

Squamous cell carcinoma of the nail bed is rare, and the disease is often misdiagnosed as a benign condition. Digital amputation is often performed because of the delay in diagnosis and the involvement of the distal phalanx. Between March 1999 and March 2002, 3 patients presented to the Pamela Youde Nethersole Eastern Hospital, Hong Kong, with squamous cell carcinoma of the nail bed. Two of the patients underwent a digit-salvaging procedure—namely, wide local excision and flap coverage—and their functional outcome was satisfactory. The remaining patient received partial amputation of the thumb without significant functional loss. A high degree of suspicion is thus needed to detect squamous cell carcinoma of the nail bed; a biopsy of chronic recurrent nail bed lesions should be performed.
Histomorphometric Changes in the Vessel Wall at the Site of Amputation in Diabetic Patients—Do They Influence Healing of the Stump?
Authors: Naidu SVLG , Sengupta S
Published: October 2016

Purpose.

To predict healing of the stump by assessing the microscopic vascular changes at the amputation site.

Methods.

A cohort study was conducted on 39 patients, 18 of them had below-knee amputation (group A) and 21 had ray amputation of a single toe (group B). Biopsies were taken from the anterior and posterior tibial arteries and the venae comitantes of group A patients. For group B patients, biopsies of the digital artery and dorsal vein of the toe were taken.

Results.

In group A, 15 patients required no further amputation (group A1) and 3 underwent a further above-knee amputation (group A2). In group B, 16 required no further amputation (group B1) and 5 underwent a below-knee amputation (group B2). Lumen narrowing caused by intimal thickening of the arteries was significantly different between groups A1 and A2 (p<0.05). Lumen narrowing of the dorsal veins between groups B1 and B2 was also significantly different (p<0.05). The proportion of the vessel walls made up of intima and media was significantly different in both A1 and A2 as well as B1 and B2 groups. The proportion of total wall thickness over the total diameter of the vessel was not significantly different between both subgroups of A and B.

Conclusion.

Intimal thickening and medial thinning in the arteries can be used to predict the stump healing in patients who underwent below-knee amputation. For ray amputation patients, similar changes occurred in the dorsal veins, and this finding can also be used to predict the healing of the stump. However, intimal thickening occurred at the expense of the media; therefore, there is little change in the wall thickness.
Lower-Extremity Amputation: A 6-Year Follow-up Study in Brazil
Authors: de Godoy JMP , de Godoy MF , Batigalia F , Trávolo ARF , Monteiro EHF
Published: October 2016

Purpose.

To evaluate the 6-year mortality in 50 patients following lower-limb amputation.

Methods.

The cumulative survival rate of 50 (28 men, 22 women) amputees aged 54 to 94 years (mean, 67.3; median, 73.5) was retrospectively studied from 1993 to 1998. Indications for above- or below-knee amputation were trauma (n=2), vasculitis (n=2), and critical ischaemia of the lower limbs (n=46). Leg amputation was performed after anamnesis, physical examination, and angiography. All patients were followed up for 6 years by phone or domiciliary visit. A death certificate was verified when a patient was lost to follow-up. Statistical analysis was expressed by the actuarial survival curve.

Results.

Of 50 amputees, 36 died in the 6 years following leg amputation: 22 in the first year, 3 in the second year, 5 in the third year, 2 in the fourth year, 2 in the fifth year, 2 in the sixth year; 14 remained alive after 6 years.

Conclusion.

Patients who underwent lower-limb amputation had a high 6-year mortality. Most deaths occurred in the first year.
Inducing Peripheral Sympathetic Nerve Activity by Therapeutic Electrical Stimulation
Authors: Mikami Y , Ogura T , Kubo T , Kira Y , Aramaki S
Published: October 2016

Purpose.

To examine whether the activity of peripheral sympathetic nerves in animals with spinal cord injury can be controlled using therapeutic electrical stimulation.

Methods.

The spinal cords of 6 Wistar rats were severed at T12/T13 disk level and were given continuous therapeutic electrical stimulation. Microneurography was used to record sympathetic nerve activity at 24, 48, and 72 hours after severing the spinal cord.

Results.

Integrated values of muscle sympathetic nerve activity after 72 hours of therapeutic electrical stimulation revealed significantly larger potentials on the stimulated side than the non-stimulated side. Skin sympathetic nerve activity showed no difference between the 2 sides.

Conclusion.

Therapeutic electrical stimulation was found to have a facilitatory effect on the muscle sympathetic nerve activity, whereas regulatory function was activated by the sympathetic nerves.
Curettage and Radiotherapy of Giant Cell Tumour of the Sacrum: A Case Report with a 10-Year Follow-up
Authors: Kanamori M , Ohmori K
Published: October 2016

A case report of a 53-year-old woman with giant cell tumour of the sacrum is presented. Initial curettage was performed through a posterior approach and the patient was relieved of pain and discharged. However, 6 months later the patient was readmitted with a tumour that had progressed towards the L5 vertebra. A further curettage followed by adjuvant radiotherapy resulted in successful reduction of the tumour. Ten years after the operation, there was no recurrence or metastasis.
Long-Term Follow-up of a Recurrent Multifocal Desmoid Tumour Treated with Tamoxifen: A Case Report
Authors: Gwynne-Jones DP , Theis JC , Jeffery AK , Hung NA
Published: October 2016

We report a long-term follow-up of a female patient with a multifocal extremity desmoid tumour. She had 3 local recurrences after excision and developed a second unresectable pelvic tumour that has remained unchanged in size for 14 years since starting tamoxifen treatment.
Ganglion Cyst of the Anterior Cruciate Ligament: A Case Report
Authors: Dinakar B , Khan T , Kumar AC , Kumar A
Published: October 2016

A ganglion is a cystic swelling that usually arises close to tendons or joints. Its occurrence inside a joint is rare, and its diagnosis is usually incidental during magnetic resonance imaging or arthroscopy. It may be painful or asymptomatic. Some patients may have a trauma history. Ganglia may mimic intra-articular lesions like tears of the anterior cruciate ligament or meniscus. Magnetic resonance imaging is the investigation of choice for diagnosis. Ganglia commonly arise from the anterior cruciate ligament, but can also arise from other structures such as the posterior cruciate ligament or meniscus. Ganglia are typically treated by arthroscopic excision and debridement. We report a case of ganglion cyst of the anterior cruciate ligament in a 16-year-old man.
Tophaceous Gout in the Bipartite Patella with Intra-Osseous and Intra-Articular Lesions: A Case Report
Authors: Kobayashi K , Deie M , Okuhara A , Adachi N , Yasumoto M , Ochi M
Published: October 2016

We report a case of a 34-year-old man who had an acute gouty attack with tophi around the accessory bone of the bipartite patella with intra-osseous lesions. As the symptoms did not respond to conservative treatments, the patient was treated surgically. Arthroscopy revealed urate crystals surrounded by inflammatory synovitis on the surface of the bipartite patella. Arthrotomy exposed the abundant crystals around the accessory bone and in the intra-osseous lesion. These findings made us speculate that some pre-existing inflammatory conditions around the accessory bone induced deposition of urate crystals, and the destruction of the barrier between the deposits and the joint led to an acute arthritis. Curettage of the tophi resulted in immediate improvement of knee function. There had been no recurrence of symptoms at the 2-year follow-up.
Acetabular Augmentation Using a Second Cup during Revision Hip Arthroplasty: An Unusual Case Report
Authors: Kamath S , Campbell AC
Published: October 2016

Acetabular wedge augmentation is a useful technique and is recommended in situations where cup revision is likely to be excessively difficult. Numerous augmentation designs that improve the stability of the hip are now available in the market. Occasionally, however, these devices are not readily available, particularly if problems such as instability and dislocation are not anticipated preoperatively. We report our experience in treating such a case, using an augment cut from a second cup with a follow-up for 30 months. Though there is no substitute for proper preoperative planning, awareness of this procedure is helpful as unexpected problems do arise in revision acetabular surgery.
Schwannomas of the Hand and Wrist: Long-Term Results and Review of the Literature
Authors: Ozdemir O , Kurt C , Coskunol E , Calli I , Ozsoy MH
Published: October 2016

Purpose.

To review the long-term results of 14 cases of histopathologically confirmed schwannoma of the hand and wrist treated with intracapsular tumour removal.

Methods.

All operations were performed under loupe magnification and microsurgical dissection, and the tumour was removed after capsular (including endoneurium) incision. Patients were assessed for any residual symptoms. Sensory testing of light touch and pain was carried out.

Results.

The mean age of the patients at the time of operation was 38.4 years (range, 11–78 years), and the mean follow-up period was 12.6 years (range, 3–36 years). Ten of the tumours were located in the median nerve distribution, whereas 4 in the ulnar nerve distribution. Four tumours were at the wrist level, 3 at the palm level, and 7 at the digital level (3 in the index finger). Only 5 patients were correctly diagnosed preoperatively. Neurological loss was not recovered in one patient in whom the tumour was resected with the digital nerve. No recurrence or muscle atrophy was noted at the latest follow-up.

Conclusion.

Meticulous dissection with magnification can achieve complete tumour removal without neurological loss or recurrence. Intracapsular tumour removal provides good results with a low complication rate.
Intradural Spinal Tuberculosis in the Absence of Vertebral or Meningeal Tuberculosis: A Case Report
Authors: Harsha CK Sree , Shetty AP , Rajasekaran S
Published: October 2016

We present a patient with spinal intradural tuberculosis in the absence of both vertebral and meningeal tuberculosis. Diagnosis was made based on intra-operative findings and was confirmed by histopathology. Early surgical decompression along with a combination of steroid and antitubercular therapy resulted in a good outcome. At 26-month follow-up, the patient regained bladder control and was able to walk with support. Clinical features, magnetic resonance imaging, and intra-operative findings are described. Pathology and the relevant literature are discussed.
Mechanical Failure in Intramedullary Interlocking Nails
Authors: Bhat AK , Rao SK , Bhaskaranand K
Published: October 2016

Purpose.

To study clinical and mechanical factors that predispose to failure of interlocking nails.

Methods.

Between October 1996 and December 2002, 286 femoral fractures, 211 tibial fractures, and 47 humeral fractures were repaired using variously designed interlocking nails. Fracture pattern, level and site, nail size and type, weight bearing after nailing, and union status were reviewed after a mean follow-up of 22 months.

Results.

Nail failure occurred in 27 fracture repairs (17 femoral, 9 tibial, and one humeral; 13 from our institution and 14 referred from elsewhere). In 55% of failed repairs, the fracture was distal. A high rate of tibial nail failure was noted.

Conclusion.

Distal fractures and stress concentration at the distal screws predispose to interlocking nail failure and can be prevented by protected weight bearing combined with the use of longer and larger nails. Routine supplementary cancellous bone grafting is unnecessary during renailing surgery when adequate reaming and a larger nail are used.
15-Year Follow-up Results of the Hydroxyapatite Ceramic—Coated Femoral Stem
Authors: Slack R , Tindall A , Shetty AA , James KD , Rand C
Published: October 2016

Purpose.

To evaluate the clinical and radiological outcomes following implantation of the Furlong hydroxyapatite ceramic–coated femoral stem in total hip arthroplasty.

Methods.

A longitudinal cohort of 116 consecutive patients (134 hips) was followed up prospectively. The follow-up period was at least 13 years (range, 13–15 years). Clinical and radiological assessments were made using the Merle d'Aubigne and Postel score and Engh score for fixation and stability, respectively. Osteointegration was assessed radiographically by examining the bone implant interface using the method described by Gruen.

Results.

22 patients died during the study period and 6 were lost to follow-up. The respective mean Merle d'Aubigne and Postel scores for pain, range of movement, and ability to walk were 2.2, 2.8, and 2.4 preoperatively and 5.8, 4.8, and 5.4 postoperatively. Engh described satisfactory bony ongrowth as 10 points or more; the mean Engh score for fixation and stability was 24.7 (fixation=10, stability=14.7). One femoral stem was revised for a periprosthetic fracture caused by a fall, but none was revised for loosening. This gave a 99% survival at 13 years (95% confidence interval 94–100).

Conclusion.

The long-term results of this hydroxyapatite ceramic–coated femoral prosthesis are very satisfactory.
Effect of Drain Pressure in Total Knee Arthroplasty
Authors: Cheung KW , Chiu KH
Published: October 2016

Purpose.

To study the effect of drain suction pressure on drainage volume, decrease in haemoglobin level, blood transfusion, and wound complications following total knee arthroplasty.

Methods.

Primary total knee arthroplasty for degenerative osteoarthritis was performed in 60 (49 female and 11 male) patients. Patients were randomised for high-pressure (600 mm Hg) or low-pressure (350 mm Hg) postoperative suction drainage. Drain output was recorded daily and the drain removed after 48 hours. Postoperative haemoglobin level was measured on the evening of the operation day and on postoperative day 2.

Results.

The high-pressure group had a significantly higher drainage volume and decrease in haemogloblin level than the low-pressure group. However, there was no significant difference between groups in the transfusion rate, number of units of blood transfused, wound discharge, or Knee Society knee and function scores. No wound infection was detected in any patient.

Conclusion.

Low-pressure suction drainage results in less blood loss without a significant increase in wound complications.
Stress Fracture of the Distal Tibia Secondary to Severe Knee Osteoarthritis: A Case Report
Authors: Tey IK , Chong KW , Singh I
Published: October 2016

Stress fracture of the tibia secondary to sports-related activities is relatively common, but rarely occurs secondary to osteoarthritis of the knee. Such fractures usually involve the proximal tibia. We report a 61-year-old woman with osteoarthritis and severe varus deformity of the knee who had a stress fracture of the distal tibial shaft. The patient had declined total knee replacement for severe osteoarthritis. She developed a stress fracture that subsequently malunited. The patient presented late and the diagnosis was not made for several months. The pathomechanics, diagnosis, and management options for this patient are discussed.
Pseudomalignant Myositis Ossificans Mimicking Osteosarcoma: A Case Report
Authors: Ragunanthan N , Sugavanam C
Published: October 2016

An ossifying soft-tissue lesion is potentially malignant. The possibility of malignancy increases in the absence of significant trauma. Pseudomalignant myositis ossificans can be easily confused with malignant lesions. A 22-year-old man presented with an ossifying mass in the adductor compartment of the thigh. The mass was excised and histopathologically reported as a soft-tissue osteosarcoma, but was later confirmed as pseudomalignant myositis ossificans by a pathologist specialising in oncology. Careful consideration and correlation of clinical, radiological, and histopathological findings is required to ensure the correct diagnosis is made and both initial and ongoing management is appropriate.
Retrograde Nailing for Distal Third Femoral Shaft Fractures: A Prospective Study
Authors: Acharya KN , Rao MR
Published: October 2016

Purpose.

To evaluate the postoperative knee function and results of unreamed retrograde nailing for distal third femoral shaft fractures.

Methods.

Between January 2002 and 2003 inclusive, a consecutive series of 27 patients (with 28 fractures) who underwent retrograde nailing were prospectively evaluated. Outcome measures were union time, initiation of weight bearing, deformity and shortening, functional length of the nail, knee function assessed using a modified Knee Society Knee Score. Correlations between union time and other variables were also studied.

Results.

In these patients 26 (93%) of the 28 fractures achieved union, of which 5 underwent dynamisation; the mean union time for the other 21 fractures was 4.4 months. Angular malalignment was present in 4 patients and shortening in 4 others. There was negligible correlation between union time and variables of nail-canal diameter mismatch, functional length of nail, fracture geometry, or initiation of partial weight bearing ambulation. Knee flexion of more than 100 degrees was achieved in 26 patients. 19 patients had anterior knee pain and 10 had instability. By the end of one year, excellent or good scores for pain and function were recorded in 77% and 73% respectively, of the 26 patients.

Conclusion.

In view of such favourable union rates but significant deterioration in overall knee joint function, at best retrograde nailing is a reliable alternative in the management of selected complicated fractures of the distal femoral shaft.
Locking Compression Plate in the Treatment of Forearm Fractures: A Prospective Study
Authors: Leung F , Chow SP
Published: October 2016

Purpose.

To evaluate the use of locking compression plates (LCPs) in diaphyseal forearm fractures.

Methods.

9 women and 23 men (mean age, 35; range, 12–70 years) with 45 forearm fractures were treated by open reduction and internal fixation with 3.5-mm stainless steel LCPs. All patients were followed up monthly until union; the mean duration being 20 months. Radiographic assessment was performed at 3, 6, 12, and 18 months. Clinical assessments regarding pain and function were undertaken at the final follow-up.

Results.

Two patients had delayed union but none had nonunion. There was no deep infection and only one superficial infection. Two refractures occurred after implant removal, both were of simple transverse type and at the sites of the original fractures. 33% of the fractures were reduced anatomically. 56% of the fractures healed with no or minimal callus formation and 44% with moderate callus formation. In total, 13% of the anatomically reduced fractures had moderate or abundant callus formation. 22 patients opted for removal of the implants (29 LCPs), after a mean of 16 (range, 9–21) months.

Conclusion.

The LCP is an effective bridging device used for treating comminuted fractures, but for treating simple fractures its superiority over conventional plating is yet to be proven.
Morphological Adaptation of the Bone Graft and Fused Bodies after Non-Instrumented Anterior Interbody Fusion of the Lower Cervical Spine
Authors: Moon MS , Moon YW , Kim SS , Moon JL
Published: October 2016

Purpose.

To assess the remodelling process of the bone graft and fused bodies after non-instrumented anterior interbody fusion with autogenous iliac graft in patients with spondylosis, infections, fractures, or disorders of the cervical spine.

Methods.

68 patients aged 18 to 58 years who underwent non-plated anterior lower cervical interbody fusion with an iliac graft were retrospectively studied. Diagnoses of the patients were degenerative disc diseases (n=32), disc herniation (n=15), fractures (n=13), and tuberculosis (n=8). The Robinson and Smith technique was used to treat degenerative disc diseases and protruded disc, and the Bailey and Badgley procedure for fractures or tuberculosis of the cervical spine. 34, 25, and 9 patients underwent one-, 2-, and 3-segment fusions, respectively. 18 of the 25 patients underwent two-segment fusion with a single large bone block, and 7 with 2 separate bone blocks for each segment. Four of the 9 patients underwent three-segment fusion with a single large bone block, and 5 used separate grafts for each segment independently. Plain and stress radiography was primarily used to assess the fusion. Computed tomography and magnetic resonance imaging were also used in some patients. Some anterior graft extrusion (amounting to less than 10% of corresponding anteroposterior body width) was used to observe the remodelling during graft-take and thereafter. Postoperative cervical traction for 2 to 4 weeks, then cervical collar immobilisation for 4 to 12 weeks were strictly followed according to the numbers of fused segments. A halo vest was applied in 4 patients with fracture undergoing 3-segment fusion as they could not tolerate the prolonged bed rest or rigid cervical brace.

Results.

The mean time for the graft to fuse was 8.6 (range, 7–14) weeks in patients who underwent each segment fusion with independent free grafts, and 10 and 14 weeks in those who underwent 2- and 3-segment single large graft fusion, respectively. The final loss of disc height and joint angle were negligible, regardless of the extent of fusion. Bony absorption of the anteriorly protruded part of the graft began at postoperative week 10 (range, 6–28), which coincided with the time of graft-take and initiation of remodelling.

Conclusion.

The earliest sign of bony absorption of the anteriorly protruded part of the graft indicated the initiation of the graft-take and the graft remodelling. The inwaisting sign of the surgically fused block of vertebral bodies was a morphological adaptation. Despite the altered biomechanics of the spine in the fused area, the inwaisting sign indicated maintenance of normal function at the parafusion motion segments.
Concomitant Ipsilateral Traumatic Dislocation of the Hip and Knee following High-Energy Trauma: A Case Report
Authors: Motsis EK , Pakos EE , Zaharis K , Korompilias AV , Xenakis TA
Published: October 2016

Traumatic dislocation of the hip or knee can occur after high-energy trauma and is often associated with concomitant injuries and secondary complications. Concomitant traumatic dislocation of both hip and knee is rare. We describe a case of combined ipsilateral posterior hip dislocation with a posterior acetabular fracture and a complete open knee dislocation with disruption of the popliteal artery that resulted in amputation.
Reproducibility of the Gartland Classification for Supracondylar Humeral Fractures in Children
Authors: Heal J , Bould M , Livingstone J , Blewitt N , Blom AW
Published: October 2016

Purpose.

To evaluate the intra- and inter-observer reproducibility of the Gartland radiographic classification for supracondylar humeral fractures in children.

Methods.

Anteroposterior and lateral radiographs of 50 supracondylar humeral fractures in children were graded on 2 separate occasions by 4 orthopaedic surgeons according to the Wilkins modification of the Gartland classification. Data were analysed by calculating the Kappa values for intra- and inter-observer agreement to indicate the reproducibility of the classification.

Results.

There was moderate inter-observer agreement, except for poor agreement over type I fractures. Type II fractures only showed fair to moderate agreement. Type III fractures and the flexion group showed good to very good agreement. Intra-observer agreement was good to very good.

Conclusion.

Surgeons should treat paediatric supracondylar humeral fractures based on an assessment of the degree of displacement rather than by employing the Gartland classification.
Promotion of Medial Collateral Ligament Healing Using a High-Voltage Electrical Field
Authors: Ito MM , Murase K , Tanaka S , Matsushita T
Published: October 2016

Purpose.

To assess the biomechanical and histological effects of a high-voltage electrical field on ligament healing.

Methods.

54 male Wistar rats were used. The medial collateral ligaments (MCLs) of 6 rats were measured for normal biomechanical failure load and stiffness. MCLs of the remaining 48 rats were transected and randomly assigned; half were subjected to a high-voltage electrical field for 8 hours a day (experimental group), and the other half were kept under normal conditions (control group). Eight rats from each group were killed 2, 4, and 6 weeks after the transection and their MCLs were tested biomechanically and histologically.

Results.

Failure load and stiffness of the MCLs in the experimental group were significantly higher than those in the control group 2 weeks after transection, but not thereafter. At week 2, the granulation tissue completely occupied the space between the cut ends of the MCL in the experimental group, whereas some gaps remained in the control group.

Conclusion.

A high-voltage electrical field appear to accelerate ligament healing in the initial 2 weeks. Earlier initial healing may allow earlier start of the rehabilitation.
Tensile Strength of Modified 4-Strand Cruciate Technique for Transversely or Obliquely Lacerated Tendons
Authors: Yuen MH , Ip WY
Published: October 2016

Purposes.

To assess the tensile strength of the modified 4-strand cruciate technique for obliquely lacerated tendons, and to compare the findings with the strength of transversely lacerated tendons repaired at various grasping depths.

Methods.

60 porcine front foot tendons were evenly divided into 4 groups. In groups 1 to 3, tendons were transversely lacerated and repaired with grasping points at both ends away from the laceration by 5 mm, 10 mm, and 15 mm respectively. In group 4, tendons were obliquely lacerated and repaired with a grasping point 5 mm away from the laceration on one end and 15 mm on the other. All tendons were repaired with a modified 4-strand core suture and continuous epitendinous suture, and then tested to failure in a tensile machine.

Results.

The tensile strength in group 1 was significantly lower than that in the other 3 groups (p<0.005). The tensile strength in group 4 was not significantly different from groups 2 and 3.

Conclusion.

The tensile strength of modified 4-strand cruciate repair configuration is not weakened in obliquely lacerated tendons; the grasping point at one end of the tendon being 15 mm away from laceration provides sufficient strength to compensate for the relatively weak 5-mm end. So long as one grasping point is away from the laceration site by 10 mm, the ultimate tensile strength of the transversely lacerated tendons appears acceptable. The modified 4-strand cruciate repair is safe to use for repairing obliquely lacerated tendons.
Paediatric Trauma Epidemiology in an Urban Scenario in India
Authors: Tandon T , Shaik M , Modi N
Published: October 2016

Purposes.

To identify the epidemiology of paediatric trauma in an urban scenario of India and compare results with studies from developed countries, and to formulate preventive measures to decrease such traumas.

Methods.

Between January 2004 and 2005 inclusive, 500 paediatric, orthopaedic trauma patients presenting to our hospital were prospectively studied. Information was recorded in a prescribed proforma.

Results.

The children's ages ranged from 0 to 16 years; 274 were males. Most fractures occurred in children aged 7 to 12 years and decreased in older children. The ratio of fractures in left versus right upper extremity was 2:1. In children aged 0 to 6 years, the most common injured site was the elbow, whereas in children aged 7 to 16 years it was the distal radius. In descending order, most injuries were sustained at home (47%), in school (21%), due to sports (17%), and due to vehicular accidents (13%).

Conclusion.

An effective accident prevention programme in developing countries requires changes in lifestyle and environment, and overcoming obstacles such as ignorance, illiteracy, and inadequate resources.
The Efficacy of Methotrexate-Impregnated Hydroxyapatite Composites on Human Mammary Carcinoma Cells
Authors: Vechasilp J , Tangtrakulwanich B , Oungbho K , Yuenyongsawad S
Published: October 2016

Purpose.

To investigate the efficacy of local biodegradable composites of hydroxyapatite, plaster of Paris, and a binder of either alginate or chitosan impregnated with methotrexate on human mammary carcinoma cells.

Methods.

An in vitro analysis of drug dissolution and a cytotoxicity test on human mammary carcinoma cells were performed over one month. Physicochemical properties of each composite were investigated using scanning electron microscopy, X-ray diffractometry, and Fourier transform infrared spectroscopy.

Results.

Both composites with a binder of either alginate or chitosan could release methotrexate for over one month. The amount of methotrexate released depended on the amount of methotrexate loaded. The composite using alginate as a binder released a significantly greater amount of methotrexate than that using chitosan as a binder (p<0.05). The elution of both composites showed favourable cytotoxicity when the concentration was greater than 5 μg/ml.

Conclusion.

Methotrexate-impregnated hydroxyapatite composites appear to be effective local skeletal methotrexate delivery systems against human mammary carcinoma cells in an in vitro model.
Non-Osseous Extra-Articular Anterolateral Talocalcaneal Coalition: A Case Report
Authors: Solomon LB , Ruhli F , Ferris L , Taylor J , Henneberg M
Published: October 2016

We report a case of an extra-articular talocalcaneal coalition located anterolateral to the sinus tarsi. As non-osseous coalitions can be difficult to diagnose, physicians should keep this variant in mind in cases of a symptomatic hind foot with apparently equivocal radiological findings.
Gluteal Compartment Syndrome following Joint Arthroplasty under Epidural Anaesthesia: A Report of 4 Cases
Authors: Kumar V , Saeed K , Panagopoulos A , Parker PJ
Published: October 2016

Compartment syndrome is characterised by an increase in the interstitial pressure within a closed osseofascial compartment. This may be due to a decrease in compartment volume, an increase in compartment content or external pressures. We report 4 patients who required surgical decompression for gluteal compartment syndrome that developed after joint arthroplasty. Gluteal compartment syndrome is rare, has high morbidity, and can be life threatening if not detected early. We emphasise the importance of identifying patients at risk, frequent monitoring of patients with continuous epidural infusions, reporting of motor blockade, and regular changing of the patient's position postoperatively.
Immediate Interlocking Nailing versus External Fixation Followed by Delayed Interlocking Nailing for Gustilo Type IIIB Open Tibial Fractures
Authors: Park HJ , Uchino M , Nakamura K , Ueno M , Kojima Y , Itoman M , Yokoyama K , Suzuki T , Nemoto M
Published: October 2016

Purpose.

To compare immediate interlocking nailing with external fixation followed by delayed interlocking nailing, for Gustilo type IIIB open tibial fractures.

Methods.

23 patients with Gustilo IIIB open tibial fractures were treated with either immediate unreamed interlocking nailing (n=9) or external fixation followed by delayed unreamed interlocking nailing (n=14). Patient age, sex ratio, fracture site, fracture type, and severity were similar in both groups. The time to union, deep infection rate, and nonunion rate in the 2 groups were compared.

Results.

In the immediate and delayed nailing groups, respective mean times to union were 21 (standard deviation [SD], 14) months and 14 (SD, 8) months; nonunion rates were 44% (4/9) and 36% (5/14), and deep infection rates were 22% (2/9) and 7% (1/14). All corresponding differences were not statistically significant.

Conclusion.

Prospective, randomised, multicentre studies are needed to assess whether there are significant differences between the 2 treatment methods.
Knee Flexion after Total Knee Arthroplasty
Authors: Li PH , Wong YC , Wai YL
Published: October 2016

Purpose.

To identify factors related to knee flexion after total knee arthroplasty in a Chinese population.

Methods.

Records of 242 total knee arthroplasties were retrospectively reviewed. The parameters evaluated were age, gender, diagnosis, preoperative knee flexion and extension, preoperative flexion arc, tibiofemoral angle, Knee Society knee score and functional score, and implant design.

Results.

Advanced age, female gender, and good preoperative flexion and flexion arc were related to better postoperative flexion. Postoperative flexion tended to migrate to the middle range despite different ranges of preoperative flexion. Preoperative tibiofemoral malalignment had no significant effect on postoperative flexion.

Conclusion.

Contemporary designs of posterior stabilised prostheses with right and left femoral components were superior to older designs.
Staged Bilateral Hip or Knee Arthroplasties
Authors: Hashmi FR , Barlas K , Mann CF , Howell FR
Published: October 2016

Purpose.

To compare the operating time, amount of blood transfused, length of hospital stay, and early complications (within 6 months) between 2-week staged bilateral arthroplasties and matched randomised controls undergoing unilateral arthroplasties.

Methods.

From October 1992 to October 2000, 90 patients who underwent bilateral hip or knee arthroplasties with a 2-week interval were compared with matched randomised controls undergoing unilateral arthroplasties. A single surgeon performed all procedures.

Results.

After the match-up process, 30 pairs of patients were included in the analysis. There were no significant differences in the operating times, amount of blood transfused, and early complication rates. The mean difference in length of hospital stay was significant ( t= −3.552, df=29, p<0.001).

Conclusion.

Compared to staged procedures with an interval months apart, staged sequential arthroplasty with a 7- to 10-day interval during one hospital admission is more efficient, as it facilitates earlier rehabilitation without higher complication rates, and entails shorter hospital stays.
Posterior 360-Degree Stabilisation of the Upper Thoracic Spine: A Technical Note
Authors: Timbihurira G , Nakajima H , Kobayashi S , Sato R , Yayama T , Uchida K , Horiuchi Y , Baba H
Published: October 2016

Purpose.

To describe a technique involving posterior 360-degree stabilisation of the upper thoracic spine: spinal cord decompression, posterior vertebral body replacement, and then posterior instrumentation and intercostal posterolateral vertebral stabilisation.

Methods.

Three men and 4 women aged 41 to 77 (mean, 58) years underwent posterior 360-degree stabilisation of the upper thoracic spine. Their indications for surgery were bone metastasis (n=5), burst fracture (n=1), and osteoporotic collapse with cord compression (n=1). Their clinical and radiological findings and treatment outcomes were retrospectively reviewed.

Results.

Pain status of all patients improved after surgery: 4 had severe and 3 had mild pain preoperatively; in 3 pain became minimal and 4 had none postoperatively. All patients except one had Frankel/American Spinal Injury Association scores of E after surgery indicating complete recovery of sensory and motor function. There were no complications related to surgery or instrumentation construct. At the time of review, one patient had died of old age 8.6 years after surgery and another from local recurrence and lung metastasis 5.7 years after surgery. All other patients were living.

Conclusion.

One-stage posterior 360-degree stabilisation and vertebral body replacement is a useful technique for upper thoracic spine surgery.
Review Article: Anatomic Double Bundle Anterior Cruciate Ligament Reconstruction
Authors: Shen W , Jordan S , Fu F
Published: October 2016

The anterior cruciate ligament (ACL) consists of 2 bundles: a slightly larger anteromedial bundle and a posterolateral bundle, named according to their relative tibial insertion sites. Both bundles are crucial to knee stability. Although it is more technically demanding, a double bundle ACL reconstruction restores the knee biomechanics better and provides more rotational stability than a single bundle ACL reconstruction. Intermediate and long-term clinical investigation including the measurement of rotational laxity and the evaluation of osteoarthritic change is needed to confirm biomechanical and short-term clinical outcomes.
Pyogenic Sacroiliitis and Adult Respiratory Distress Syndrome: A Case Report
Authors: Asavamongkolkul A , Keerasuntonpong A , Kuagoolwongse C
Published: October 2016

Staphylococcus aureus sacroiliitis is uncommon and may lead to bacteraemia, sepsis, and death if diagnosis and treatment are delayed. Its association with pulmonary symptoms has not been reported. We report a 36-year-old Thai woman who presented with a 4-day history of right buttock pain, aggravated by walking, which came on after having a traditional foot massage. She later developed adult respiratory distress syndrome. She was treated with open drainage, respiratory support, and antibiotics.
Ureteropelvic Junction Disruption and Distal Ureter Injury Associated with a Chance Fracture following a Traffic Accident: A Case Report
Authors: Slobogean GP , Tredwell SJ , Masterson JST
Published: October 2016

A 10-year-old girl sustained a ureteropelvic junction disruption and distal ureter injury associated with the Chance fracture following a traffic accident. She was sitting on the rear seat of a car wearing a lap belt. Extensive small bowel mesenteric trauma was noted. Radiography revealed a left haemothorax with mediastinal shift and an unstable flexion-distraction vertebral fracture at L2 (Chance fracture). Subsequent intravenous pyelography demonstrated proximal extravasation from the right kidney without continuity to the upper and mid ureter, indicating a ureteropelvic junction avulsion or necrosis. Definitive surgery was delayed until day 33 because of urosepsis. Due to extensive small bowel resection, ischaemia of the ureter, and the history of urosepsis, a right subcapsular nephrectomy (rather than ureteral reconstruction) was considered the safest option for minimising further complications. It is important that trauma specialists recognise additional injuries after major trauma. Early use of a multidisciplinary approach is recommended to reduce morbidity and mortality.
Proximal Femoral Nail for Treatment of Trochanteric Femoral Fractures
Authors: Morihara T , Arai Y , Tokugawa S , Fujita S , Chatani K , Kubo T
Published: October 2016

Purpose.

To report outcomes of 87 consecutive patients treated with a proximal femoral nail (PFN) for trochanteric femoral fractures.

Methods.

17 men and 70 women aged 58 to 95 (mean, 85) years with trochanteric femoral fractures underwent PFN fixation using an intramedullary nail, a lag screw, and a hip pin. Fractures were classified according to the AO system; the most common fracture type was A2 (n=45), followed by A1 (n=36) and A3 (n=6). The position of the lag screw within the femoral head was measured. The lateral slide of the lag screw after fracture consolidation was measured by comparing the immediate postoperative and final anteroposterior radiographs.

Results.

90% of lag screws were placed in an optimal position. The length of lateral slide of the lag screw in stable A1 fractures was significantly less than that in unstable A2 fractures; it was over 10 mm in 7 of 45 patients with A2 fractures. Cut-out of lag screw did not occur, suggesting that free sliding of the lag screw facilitates direct impaction between fragments.

Conclusion.

A PFN is useful for the treatment of trochanteric femoral fractures.
Intramedullary Nailing for Pathological Femoral Fractures
Authors: Sharma H , Bhagat S , McCaul J , MacDonald D , Rana B , Naik M
Published: October 2016

Purpose.

To evaluate whether the operating time correlates with the survival and outcome in patients who underwent intramedullary nailing for metastatic femoral fractures.

Methods.

Records of 10 men and 11 women aged 43 to 86 (mean, 66) years who underwent intramedullary nailing (4 bilaterally) for metastatic femoral fractures between 1999 and 2003 were reviewed. The patients were followed up for at least 2 years or until their death. The main outcome measure was the correlation between operating time and survival. Operating time was categorised into 5 groups from 60 to 210 minutes, with 30-minute increments.

Results.

Operating time does not correlate with survival and outcome. The mean survival period was 9.4 months. Pain relief was achieved in 90% of the patients. There was no implant failure, but one loss of reduction.

Conclusion.

Intramedullary nailing appears safe and effective for treatment of metastatic bone disease, and confers good functional results, pain relief, and mobility.
Modified Brostrom-Evans-Gould Technique for Recurrent Lateral Ankle Ligament Instability
Authors: Ng ZD , De S Das
Published: October 2016

Purpose.

To review the outcome of the modified Brostrom-Evans-Gould technique in patients with chronic lateral ankle ligament instability.

Methods.

Between August 2003 and June 2005, 20 men aged 19 to 35 (mean, 23) years with chronic lateral instability affecting 21 ankles, underwent the modified Brostrom-Evans-Gould technique by a single surgeon. The mean follow-up period was 12 (range, 6–20) months. Patients were assessed preoperatively and postoperatively using the Kaikkonen Ankle Scoring Scale.

Results.

Preoperatively, all patients had poor scores (<50). Postoperatively, 17 (81%) of the ankles attained excellent scores (85–100) and 4 (19%) attained good scores (70–84).

Conclusion.

The modified Brostrom-Evans-Gould technique appears effective for chronic lateral ankle ligament instability, particularly in the Asian population with a higher prevalence of generalised joint hyperlaxity.