bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between Magnetic Resonance Imaging and Radiographic Measurement of Cervical Spine in Cervical Myelopathic Patients
Authors: Wong TM , Leung HB , Wong WC
Published: October 2016

Purpose.

To correlate the radiographic measurement, cord diameter shown on magnetic resonance imaging (MRI), and clinical hand sign of cervical myelopathic patients.

Methods.

Patients with clinical cervical myelopathy who had had MRI in Kwong Wah Hospital between January 2001 and December 2002 were enlisted. Their cervical spine radiographs and clinical records were reviewed.

Results.

Of 36 patients with a complete set of MRI films, cervical spine radiographs, and clinical notes; 18% did not have Hoffman's sign, 47% had normal supinator reflex, 39% had unimpaired 10-second test, and 45% showed no finger escape sign. The presence of myelopathic hand signs was not correlated to any radiological assessment, cord diameter, or presence of myelomalacia at any level.

Conclusion.

Cervical spine radiography cannot predict the level and degree of cervical spinal cord compression. Myelopathic hand signs are not diagnostically fail-safe and cannot predict the level and degree of cord compression.
Modified Calcaneal Index: A New Screening Tool for Osteoporosis Based on Plain Radiographs of the Calcaneum
Authors: Pande KC , Pande SK , de Takats D , McCloskey EV
Published: October 2016

Purposes.

To assess osteoporosis using plain radiography of the calcaneum by studying the performance characteristics of the modified calcaneal index through inter- and intra-observer agreement. To study the correlation of the modified calcaneal index to quantitative ultrasound of the calcaneus and bone mineral density (BMD) of the femoral neck and distal radius.

Methods.

Lateral calcaneal radiographs of 252 women who participated in a clinical trial for osteoporosis were reviewed. The BMD of the hip and distal radius was measured and the calcanea were assessed using ultrasound. The calcaneal radiographs were graded by 3 clinicians according to a previously described 5-grade calcaneal index. A modified 3-grade calcaneal index was then developed.

Results.

The highest scores of intra- and inter-observer reliability of the modified calcaneal index were 0.45 and 0.40, respectively, which were higher than those of the 5-grade calcaneal index. The correlation of the modified calcaneal index with other measures was significant (hip BMD, r=0.31; distal radius BMD, r=0.28; calcaneal speed of sound, r=0.20; broadband ultrasound attenuation, r=0.36) [p<0.005]. There were significant differences in hip BMD, distal radial BMD, calcaneal speed of sound, and broadband ultrasound attenuation between the 3 grades of the modified calcaneal index (Kruskal-Wallis 1-way ANOVA; p<0.0001).

Conclusion.

The modified calcaneal index can be used to measure bone structure and skeletal strength and is a suitable screening tool for osteoporosis in places where advanced approaches to bone-status assessment are not available.
Femoral Neck Fractures Complicating Metal-on-Metal Resurfaced Hips: A Report of 2 Cases
Authors: Sharma H , Rana B , Watson C , Campbell AC , Singh BJ
Published: October 2016

Metal-on-metal hip resurfacing arthroplasty is increasingly popular for younger patients with advanced hip disease. Intra-operative or immediate postoperative femoral neck fracture after metal-on-metal hip resurfacing is a well-described technical complication, ranging from 0% to 1.5%. We report 2 cases of late femoral neck fracture occurring 8 and 15 months following the index operation, with a review of the literature. We recommend that patient selection should be of prime importance before embarking on metal-on-metal surface hip replacement to avoid such complications.
Knee Dislocation of a Morbidly Obese Patient: A Case Report
Authors: Shetty RR , Mostofi SB , Housden PL
Published: October 2016

Knee dislocations of morbidly obese patients after a trivial fall are not uncommon. We report a case of closed reduction for a dislocated right knee of a 26-year-old obese woman. After closed reduction under general anaesthesia, her knee was supported by pillows in 30 degrees flexion. No external splint was used because of the enormous size of the leg. At day 4 after reduction, the patient had numbness over the dorsum of the right foot and was unable to dorsiflex. She was diagnosed as having peroneal nerve palsy and was fitted with a foot drop splint. One week after reduction, she started active, assisted knee mobilisation and tip-toe weight bearing. At 24 months after reduction, the patient was able to walk unaided and had 100 degrees of knee flexion. She had a good foot function and a grade II in the Lachman's test, with no varus or valgus instability. This case highlights the importance of early mobilisation, which can result in good outcome even without operative treatment.
Dysplasia Epiphysealis Hemimelica of the Talus: Two Case Reports
Authors: Bhosale SK , Dholakia DB , Sheth BA , Srivastava SK
Published: October 2016

Trevor's disease, also known as dysplasia epiphysealis hemimelica, is an uncommon skeletal developmental disorder representing an osteochondroma occurring in one or more epiphyses. We present 2 cases of dysplasia epiphysealis hemimelica in an 8-year-old female and a 12-year-old male who suffered from a hard swelling of the ankle joint. The female patient was treated by surgical excision and the male patient conservatively.
Delayed Diagnosis of Ewing's Sarcoma of the Right Humerus Initially Treated as Chronic Osteomyelitis: A Case Report
Authors: Tow BPB , Tan MH
Published: October 2016

We report a case of limited stage Ewing's sarcoma which was initially treated as chronic osteomyelitis for 3 years. A 24-year-old man presented with a one-week history of pain in the right arm and fever, with histology suggestive of osteomyelitis of the affected humerus. He developed multiple relapses of pain and fever; each episode responded to antibiotic treatment. A second biopsy was performed 3 years later and confirmed a diagnosis of Ewing's sarcoma. Despite a 3-year delay in diagnosis, the disease remained localised. This case report highlights an atypical facet of the natural history of Ewing's sarcoma: a response to antibiotic and anti-inflammatory agents, and the limited stage of the disease despite a misdiagnosis of 3 years. This suggests the possibility that anti-inflammatory agents exert an inhibitory effect on the tumour growth. We also highlight the newer histologic and immunologic staining used in the diagnosis of Ewing's sarcoma.
Perforated Appendicitis Causing Thigh Emphysema: A Case Report
Authors: Ushiyama T , Nakajima R , Maeda T , Kawasaki T , Matsusue Y
Published: October 2016

We report a case of thigh emphysema resulting from perforated appendicitis. The patient was an 83-year-old man who had no apparent abdominal signs and was initially misdiagnosed as having psoas abscess. Magnetic resonance imaging of the pelvis revealed appendicitis, and a barium enema showed a leakage of enhanced contrast material from the appendix region down into the thigh. A retroperitoneal perforation of the retrocaecal appendix without peritonitis was diagnosed. The patient underwent an appendectomy and curettage of the retroperitoneal and psoas muscle spaces, as well as the thigh. He recovered gradually, though the abscess had extended into the hip joint and resulted in osteomyelitis, requiring an additional procedure of resection arthroplasty. The patient fully recovered with no signs of infection one year postoperatively.
Implications of the Changing Pattern of Bacterial Infections following Total Joint Replacements
Authors: Ip D , Yam SK , Chen CK
Published: October 2016

Purpose.

To retrospectively review the causative organisms isolated from infected hip and knee replacements requiring revision.

Methods.

We reviewed a consecutive series of 36 patients who underwent revision hip or knee arthroplasties due to bacterial infection at Pamela Youde Nethersole Eastern Hospital in Hong Kong between 1995 and 2003. The male to female ratio was 1:2, and the mean age of patients was 70 years (range, 54–82 years). The mean duration of follow-up was 3.8 years (range, 1.1–8.3 years). No patient was lost to follow-up. All 14 revision knee patients had previously undergone cemented and patella-resurfacing total knee arthroplasties. Of the 22 revision hip patients, 9 had cementless, 6 had cemented, and 7 had hybrid total hip arthroplasties previously.

Results.

None of the bacteria isolated from 1995 to 1996 were multiple-drug resistant. Subsequently, however, most of the isolates were multiple-drug resistant, with methicillin-resistant Staphylococcus aureus (MRSA) being the most common. Half of the isolates of Staphylococcus epidermidis and Escherichia coli demonstrated multiple-drug resistance. The incidence of positive culture in revision hip patients was 59%, 46% of which were MRSA. All 13 revision hips with positive cultures showed chronic sepsis: 4 occurred within one year and 10 occurred 2 or more years after the index arthroplasty. The incidence of positive culture in revision knee patients was 57%, 46% of which were MRSA. All 8 revision knees with positive cultures showed chronic sepsis: 3 occurred within one year, 5 occurred 2 or more years after the index arthroplasty. Only one patient, who was infected with gram-negative bacilli, required a second revision for residual sepsis. Harris hip scores for the revision hip patients improved from a mean of 65 (range, 55–75) to 85 (range, 75–90). Knee Society knee scores of the revision knee patients improved from a mean of 68 (range, 55–75) to 80 (range, 70–85). There were no radiological signs suggestive of loosening in the 2 groups at the latest follow-up.

Conclusion.

This study found a definite increase in multiple-drug–resistant bacteria isolated from periprosthetic infections around total hip and knee prostheses.
Comparing 2-Year Outcomes of Anterior Cruciate Ligament Reconstruction Using Either Patella-Tendon or Semitendinosus-Tendon Autografts: A Non-Randomised Prospective Study
Authors: Tow BPB , Chang PCC , Mitra AK , Tay BK , Wong MC
Published: October 2016

Purpose.

To compare the results of anterior cruciate ligament (ACL) reconstructions using either a patella-tendon autograft or a semitendinosus-tendon autograft.

Methods.

Based on surgeon experience and preference, 68 patients underwent ACL reconstruction using either a quadruple-strand semitendinosus autograft (n=34) or a central one-third bone-patella tendon-bone autograft (n=34). Each patient was assessed preoperatively and postoperatively at 3, 6, and 24 months using the International Knee Documentation Committee (IKDC) knee score, Biodex muscle strength and endurance testing, and the KT1000 instrumented arthrometer test of knee laxity to anterior translation. All assessments at the 2-year follow-up were performed by the same physician and physiotherapist.

Results.

While ACL reconstruction improved knee stability and IKDC knee scores significantly, there was no statistically significant difference between semitendinosus- and patella-tendon autograft reconstructions in terms of long-term knee score or laxity to anterior translation. Semitendinosus graft reconstruction was associated with less donor-site morbidity and hamstring weakness. Meniscectomy was associated with poorer long-term knee scores.

Conclusion.

ACL reconstruction is associated with a significantly better IKDC knee score and laxity measurement at 2-year follow-up. However, we were unable to demonstrate a significantly better long-term outcome in knee score or laxity to anterior translation with either a patella-tendon autograft or a semitendinosus-tendon autograft.
Magnetic Resonance Imaging Study of the Craniocervical Junction
Authors: Tassanawipas A , Mokkhavesa S , Chatchavong S , Worawittayawong P
Published: October 2016

Purposes.

To confirm the accuracy of the standard parameters of Chamberlain's line, McGregor's line, McRae's line, and Ranawat's line in the diagnosis of basilar impression in a normal Asian population using magnetic resonance imaging (MRI) scans of the craniocervical junction, and to evaluate the use of MRI in the initial diagnosis of basilar impression.

Methods.

We retrospectively reviewed MRI scans of the craniocervical junction in 114 Thai patients (61 men and 53 women) aged 20 to 89 years to assess the lines of Chamberlain, McGregor, McRae, and Ranawat. Patients with injury, tumour, or metastasis in the craniocervial junction; congenital anomalies; or clinical symptoms and signs of basilar impression were excluded.

Results.

39 of the 114 patients had the odontoid tip extended above Chamberlain's line by 1 mm to 9 mm (mean, 2.89 mm). Only 7 men and 5 women had the tip of the odontoid process extended beyond the normal range of 5 mm. The mean distance of the odontoid tip extended past McGregor's line in male and female subjects was 0.33 mm (standard deviation [SD], 1.2 mm) and 0.17 mm (SD, 0.7 mm), respectively, markedly less than those reported previously, although one male patient's odontoid tip extended 8 mm above the McGregor's line. Regarding McRae's line, no patient had the odontoid tip extended above the foremen magnum. The mean Ranawat's line in male and female subjects was 15.75 mm (range, 12–19; SD, 1.71 mm) and 14.09 mm (range, 11–17; SD, 1.38 mm), respectively.

Conclusion.

After using MRI to confirm the standard parameters of basilar impression as previously formulated from lateral skull radiographs, we recommend using McRae's line and Ranawat's line in the initial screening for basilar impression for the Asian population. Chamberlain's line and McGregor's line are viable alternatives, but clinicians must be aware of the potential for false positives.
Bilateral Anterior Dislocation of the Shoulders with Proximal Humeral Fractures: A Case Report
Authors: Sharma L , Pankaj A , Kumar V , Malhotra R , Bhan S
Published: October 2016

Bilateral simultaneous anterior dislocation of the shoulders with bilateral 3-part fracture of the proximal humeri is unusual. A 42-year-old man presented with pain and restriction of movement on both shoulders. He was injured by a heavy object falling over his back while he was leaning forward holding an overhead bar. His arms were abducted and externally rotated. The injury was not correctly diagnosed, and the patient was treated with repeated manipulations and splintage for 2 weeks. Radiological examination revealed bilateral anterior dislocation of the shoulders with displaced 3-part fractures of the proximal humeri involving the shaft, greater tuberosity, and head. The patient was treated with open reduction and internal fixation through a deltopectoral approach using multiple Kirschner wires. The shoulders were kept immobilised for 3 weeks until the removal of the wires. The patient was able to resume work 3 months after surgery. He had an excellent and comfortable range of motion in both shoulders at one-year follow-up.
Greater Arc Injury of the Wrist with Fractured Lunate Bone: A Case Report
Authors: Amaravati RS , Saji MJ , Rajagopal HP
Published: October 2016

Carpal dislocation and fracture dislocation are uncommon and difficult to treat. Early diagnosis and treatment of such injuries are necessary to prevent progressive carpal instability and traumatic arthritis. Perilunate fracture dislocation is a combination of ligamentous and osseous injuries that involve the ‘greater arc’ of the perilunate. Despite being severe, these injuries often go unrecognised in the emergency department, leading to delayed diagnosis and treatment. We present a case of greater arc injury of the right wrist with fractures of the lunate and ulnar styloid without perilunate dislocation. This pattern of injury cannot be classified in the available literature on greater arc injury.
Posterior Lumbar Interbody Fusion versus Intertransverse Fusion in the Treatment of Lumbar Spondylolisthesis
Authors: Inamdar DN , Alagappan M , Shyam L , Devadoss S , Devadoss A
Published: October 2016

Purpose.

To compare 2 methods of fusion in the treatment of lumbar spondylolisthesis: posterior lumbar interbody fusion (PLIF) and intertransverse fusion (ITF).

Methods.

20 patients with lumbar spondylolisthesis were randomly allocated to one of 2 groups: decompression, posterior instrumentation, and PLIF (n=10) or decompression, posterior instrumentation, and ITF (n=10). The Oswestry low back pain disability questionnaire was used for clinical assessment. Radiography was performed preoperatively and postoperatively to assess the reduction of spondylolisthesis or slip.

Results.

In the PLIF and ITF groups, 87.5% and 100% had a satisfactory clinical result, and 48% and 39% had reduced spondylolisthesis, respectively. Both had a fusion rate of 100%. PLIF showed better reduction of spondylolisthesis, although ITF achieved a better subjective and clinical outcome.

Conclusion.

Morbidity and complications are much higher following PLIF than ITF. ITF is recommended because of the simplicity of the procedure, lower complication rate, and good clinical and radiological results.
Residual Nonunion following Vascularised Fibular Graft Treatment for Congenital Pseudarthrosis of the Tibia: A Report of Two Cases
Authors: Sulaiman AR , Nordin S , Faisham WI , Zulmi W , Halim AS
Published: October 2016

Resection and reconstruction using a vascularised fibular graft is a viable alternative treatment for congenital pseudarthrosis of the tibia, although distal junctional nonunion and residual deformity are known complications that are difficult to treat. We illustrate 2 cases in which bony union was achieved following a technique using fibular grafting and intramedullary nailing, without additional bone grafting. This technique was feasible because of hypertrophy of the fibular graft.
Malignant Intraosseous Peripheral Nerve Sheath Tumour of the Proximal Femur: A Case Report
Authors: Lesic A , Bumbasirevic M , Atkinson HDE , Maksimovic R , Sopta J , Atanackovic M
Published: October 2016

We report a rare case of an intraosseous malignant peripheral nerve sheath tumour of the femoral head and neck. The tumour presented as a well-defined radiolucent lesion on plain radiography. Computed tomography showed aggressive destruction of the bone with no involvement of the adjacent soft tissues. Magnetic resonance imaging revealed an isointense signal intensity on T1-weighted images, hyperintensity on T2-weighted images, and non-homogeneously increased signal intensity after administration of contrast media. The final diagnosis was based on pathohistologic analyses due to the non-specific nature of the lesion.
Difference in Stretching of Sarcomeres between Medial Gastrocnemius and Tibialis Anterior by Tibial Lengthening: An Experiment in Rabbits
Authors: Kurihashi A , Tamai K , Saotome K , Takemura M , Fujiwara A , Fujita S
Published: October 2016

Purpose.

To compare the degree of stretching of sarcomeres—in the medial gastrocnemius versus the tibialis anterior—acutely extended by tibial lengthening.

Methods.

The right lower legs of 6 New Zealand White rabbits were acutely distracted by 6.3 mm using an external fixator, whereas the left lower legs served as controls. Immediately after distraction, the ankle was dorsiflexed at 50 degrees and the knee flexed at 140 degrees, with respect to the posture of resting on the ground. Both legs were immersed in 10% buffered formalin for fixation, and the medial gastrocnemius and tibialis anterior were removed. Length of the 2 sarcomeres was measured by a laser diffraction technique using isolated muscle fibre bundles.

Results.

The mean lengths of sarcomeres in the medial gastrocnemius and tibialis anterior were 3.0 μm and 2.3 μm in the lengthened legs, and 2.4 μm and 2.1 μm in control legs, respectively. The degree of stretching of corresponding sarcomeres was therefore 25% and 10%, this difference being significant (p<0.01).

Conclusion.

Sarcomeres of the medial gastrocnemius are more stretchable than those of the tibialis anterior following tibial lengthening.
Osteonecrosis of the Femoral Head Caused by Bone Marrow Blockage: A Case Report
Authors: Nishimura A , Hasegawa M , Sudo A , Uchida A
Published: October 2016

Interruption of the blood flow may occur in intraosseous arteries within the femoral head. We report a 72-year-old woman who developed osteonecrosis of the femoral head 11 months after surgery involving massive cementing of a segmental distal femoral rotating hinge prosthesis to treat nonunion of the distal femur. The bone cement filled the cavity up to the femoral neck and the superolateral portion of the femoral head, blocking the bone marrow.
Intraosseous Epidermoid Cyst of the Finger Phalanx: A Case Report
Authors: Hamad AT , Kumar A , Kumar C Anand
Published: October 2016

Epidermoid cysts of the finger phalanx are rare pseudotumours. They are benign lesions with a satisfactory outcome after excision. We describe a case of an epidermoid cyst in the distal phalanx of the ring finger. It was treated successfully and the patient had excellent functional results and radiological healing at one-year follow-up.
True Digital Artery Aneurysm of the Ring Finger: A Case Report
Authors: Lee YHD , Teo YS , Lim YW
Published: October 2016

True aneurysms of the digital artery are very rare. Only 13 cases, caused by chronic trauma from occupational or sports-related overuse, have been reported. We present the first case of a true aneurysm of the digital artery of the left ring finger caused by chronic repetitive trauma from a wedding ring. The patient was a 44-year-old teacher who presented with a 1.5-cm subcutaneous mass on the radial aspect of the proximal phalanx of the finger, just proximal to the proximal interphalangeal joint. Exploration of the mass revealed a 1-cm aneurysm continuous with the radial digital artery. The aneurysm was excised and the proximal and distal ends of the radial digital artery ligated. Microscopic examination of the excised specimen confirmed the diagnosis of a true aneurysm with the lumen filled with an organising thrombus. The patient had an uneventful recovery with good wound healing, intact sensation, and normal capillary return.
Temporary Coracoclavicular Screw Fixation for Displaced Distal Clavicle Fractures
Authors: Fazal MA , Saksena J , Haddad FS
Published: October 2016

Purpose.

To assess the treatment outcome of temporary coracoclavicular screw fixation for displaced distal clavicle fractures.

Methods.

From January 1995 to December 2003, 30 consecutive patients with Neer type II displaced distal clavicle fractures were treated with open reduction and internal fixation using a coracoclavicular screw. The screw was removed under local anaesthesia after bony union. Patients were evaluated by clinical and radiological examination. Functional outcome was assessed by a simple shoulder test.

Results.

There was 100% union rate. All patients returned to their pre-injury activity level by 12 months. One patient developed a superficial wound infection, which resolved with oral antibiotics. Two patients had problems with mild backing out of the screw, but both had bony union by the time of screw removal. The mean score of the simple shoulder test of 28 patients was 11.

Conclusion.

Treatment outcome using temporary coracoclavicular screw fixation for displaced distal clavicle fractures is favourable. The implant is readily available and the technique is simple, safe, cost-effective, and reproducible.
Publication Bias in Abstracts Presented to the Annual Meeting of the American Academy of Orthopaedic Surgeons
Authors: Harris IA , Mourad M , Kadir A , Solomon MJ , Young JM
Published: October 2016

Purpose.

To examine possible causes of publication bias in the orthopaedic literature so as to avoid inappropriate clinical decisions based on reviews of the literature.

Methods.

Two reviewers independently reviewed abstracts presented to the 1999 American Academy of Orthopaedic Surgeons annual meeting. Data pertaining to sample size, statistical significance, study setting, country of origin, outcome, study type, and sponsorship were extracted from each abstract. The publication rate was measured after 5 years, by electronic searching and author contact. Predictors of publication were identified using logistic regression analysis.

Results.

Of the 318 abstracts listed in the proceedings, 175 (55%) were published within 5 years. Publication was associated with positive rather than neutral outcomes (odds ratio, 1.62; 95% confidence interval, 1.01–2.59; p<0.05) and with the reporting of statistical significance (odds ratio, 2.05; 95% confidence interval 1.24–3.39; p=0.005). Sponsorship, country of origin, sample size, study setting, and study type did not significantly influence the publication rate.

Conclusion.

Evidence of publication bias exists in abstracts presented at the 1999 American Academy of Orthopaedic Surgeons annual meeting. Clinical decisions based on the literature may be biased due to an over-representation of studies with positive outcomes.
Neurological Outcome following Early versus Delayed Lower Cervical Spine Surgery
Authors: Sapkas GS , Papadakis SA
Published: October 2016

Purpose.

To determine whether the timing of surgery affects neurological outcome in patients with lower cervical spine trauma.

Methods.

29 patients with a fracture and 38 with a fracture-dislocation of C3 to C7 cervical vertebrae were treated operatively during the inclusive period January 1987 to December 2000. Surgery was performed as soon as the patient's medical condition allowed, within 72 hours in 31 and more than 72 hours after the injury in 36.

Results.

Only patients with incomplete spinal cord injury had neurological improvement after surgery. There was no statistically significant difference in final neurological outcomes in patients having early as opposed to delayed surgery.

Conclusion.

Surgical intervention for cervical injuries is safe, as no postoperative neurological deterioration was recorded. Timing of surgery does not affect neurological outcome.
Reconstructions of the Shoulder following Tumour Resection
Authors: Kitagawa Y , Thai DM , Choong PFM
Published: October 2016

Purpose.

To review and compare the postoperative outcomes of 3 types of shoulder reconstructions: prosthetic arthroplasty, clavicula pro humero reconstruction, and allograft arthrodesis.

Methods.

Records of 25 shoulder reconstructions following tumour resection were retrospectively reviewed. Perioperative data, oncological prognoses, postoperative complications, and functions were assessed.

Results.

We performed 10 prosthetic arthroplasties, 7 clavicula pro humero procedures, 4 allograft arthrodeses, and 4 soft tissue reconstructions. Eight patients died of their diseases. Three developed complications and underwent revision surgery. 19 patients achieved stable shoulders. Ten patients attended for functional assessments. Respective mean scores using the Musculoskeletal Tumor Society-International Symposium on Limb Salvage and the Toronto Extremity Salvage Score were: 77% and 82% for prosthetic arthroplasties, 67% and 62% for clavicula pro humero procedures, 83% and 70% for allograft arthrodeses, and 93% and 98% for soft tissue reconstructions.

Conclusion.

A stable construct is the treatment goal for shoulder reconstructions, as it enables effective function of the arm and hand.
Bone Trephining for Osteoid Osteoma Excision: A Case Report
Authors: Osarumwense D , Esene C , Feldman A
Published: October 2016

Osteoid osteomas may be treated medically or surgically; both have similar long-term outcomes. Nonetheless, only surgery allows complete excision of the lesion for histological analysis. Excessive removal of surrounding bone may destabilise and weaken the bony structure and predispose it to fractures. We describe a surgical technique using a bone graft trephine to enable precise lesion removal with minimal bone excision.
Surgery for Clavicular and Humeral Fractures in an Osteopetrotic Patient: A Case Report
Authors: Nakayama J , Fujioka H , Kurosaka M , Kitazawa H , Maesawa N , Tomioka M
Published: October 2016

Osteopetrosis is a rare disease characterised by generalised sclerosis of the bone. Surgical treatment for fractures in osteopetrotic bones is difficult due to their hardness. We report successful surgical treatment of humeral and clavicular fractures in a 30-year-old osteopetrotic patient with severe multiple trauma. Two years after surgery, the patient had a full range of movement at the shoulder and elbow, with good bone union and alignment.
Orthopaedic Trauma Surgery Performed by Unsupervised and Supervised Trainees: Complication Rates Compared
Authors: Harris IA , Lin C
Published: October 2016

Purpose.

To compare the complication rates associated with orthopaedic trauma surgery performed by unsupervised and supervised trainees.

Methods.

In our hospital, 6361 orthopaedic trauma operations were performed between 1 January 1998 and 31 December 2002. Data pertinent to the surgeon's supervision and postoperative complications were collected. Elective operations were excluded, as consultants were almost always present. Complication rates ensuing in unsupervised and supervised groups were compared using the Chi squared test.

Results.

Of 6361 orthopaedic trauma operations performed, 3754 (59%) were by unsupervised trainees of varying experience, whereas 2494 (39%) were by supervised trainees or consultants. In 113 (2%) of the operations, the supervision status was not recorded. The complication rate was significantly higher in the supervised than unsupervised group (5.3 vs 3.3%, χ2=15, df=1, p=0.0001).

Conclusion.

The complication rate was not higher for operations performed by unsupervised trainees than those performed in the presence of a consultant.
Intramedullary Nailing versus Fixed Angle Blade Plating for Subtrochanteric Femoral Fractures: A Prospective Randomised Controlled Trial
Authors: Rahme DM , Harris IA
Published: October 2016

Purpose.

To compare closed intramedullary nailing to open reduction and internal fixation using a fixed angle blade plate for the management of subtrochanteric femoral fractures.

Methods.

58 patients were equally randomised to undergo either an intramedullary nailing (IN) or fixed angle blade plating (BP).

Results.

There were no significant differences between the 2 groups with regard to age, time to surgery, operating time, receipt of blood transfusions, duration of hospital stay, or fracture classification. The revision rate was 28% (8/29) in the BP group and none in the IN group; the difference was statistically significant.

Conclusion.

Internal fixation using a fixed angle blade plate for subtrochanteric femoral fractures has higher implant failure and revision rates, compared to closed intramedullary nailing.
Less Invasive Stabilisation System Plating for Distal Femoral Fractures
Authors: Kanabar P , Kumar V , Owen PJ , Rushton N
Published: October 2016

Purpose.

To review the outcome of less invasive stabilisation system (LISS) plating for complex distal femoral fractures.

Methods.

Records of 6 men and 11 women who underwent LISS plating for complex distal femoral fractures from September 2001 to August 2005 were reviewed. One patient who died 12 months after surgery due to a cardiac problem was excluded. The mean age of the remaining patients was 61 years and the mean follow-up period was 12 months. Four patients, 3 of whom had open fractures, had sustained high-energy trauma. According to the AO classification, 8 fractures were type 33A and 9 type 33C.

Results.

The mean time to union was 17 weeks. Two patients with non-union underwent a second LISS plating and bone grafting, resulting in a satisfactory final outcome. Delayed radiographic union was observed in one patient, but clinically he was asymptomatic and mobile. The fracture finally united at 9 months.

Conclusion.

LISS plating is useful in treating complex distal femoral fractures, resulting in reduced blood loss and low infection rates, while achieving early mobility due to primary stability of the construct.
Idiopathic Scoliosis and Pineal Lesions in Australian Children
Authors: Day GA , McPhee IB , Tuffley J , Tomlinson F , Chaseling R , Kellie S , Torode I , Sherwood M , Cutbush K , Geddes AJ , Brankoff B
Published: October 2016

Purpose.

To determine whether treatment of pineal lesions in children is associated with development of idiopathic scoliosis.

Methods.

38 boys and 10 girls with pineal lesions were identified. Their mean age at presentation was 10 years. The pineal pathology varied from cysts and epidermoid to teratoma, germinoma, pineocytoma, and glioblastoma. Treatment ranged from biopsy/extirpation to radiotherapy.

Results.

12 patients died. No scoliosis was found in any females or any of the deceased. Two boys had scoliosis: one had a 12-degree right upper thoracic curve with 32-degree kyphosis and the other had a 60-degree right thoracolumbar idiopathic curve, requiring a 2-stage arthrodesis.

Conclusion.

Pineal ablation is not related to the development of idiopathic scoliosis in humans.
Implant Infection Caused by Dermatitis: A Report of Two Cases
Authors: Lim CT , Tan KJ , Kagda F , Ang KC
Published: October 2016

We report 2 cases of implant infection with Staphylococcus aureus associated with dermatitis. In both cases, the skin at the surgical site was normal and full antiseptic measures were taken. One patient had a history of chronic asteatotic eczema complicated by cellulitis; the other had generalised exfoliative dermatitis with an atopic aetiology. Dermatitis at sites remote from the operative site may be a contributing factor in implant infection.
Pseudoaneurysm of the Geniculate Artery following Total Knee Arthroplasty: A Report of Two Cases
Authors: Law KY , Cheung KW , Chiu KH , Antonio GE
Published: October 2016

We report 2 cases of pseudoaneurysm of the geniculate artery after a total knee arthroplasty (TKA). The first one was located in the superomedial geniculate artery and resolved after compression dressing and warfarin cessation. The second one was located in the superolateral geniculate artery and was successfully treated with transarterial embolisation. There was no recurrence in both cases. The rare occurrence and delayed presentation of pseudoaneurysms pose a diagnostic challenge. A high index of suspicion is required to make the diagnosis. Early duplex Doppler ultrasonography is recommended when patients present with atypical knee pain and prolonged swelling after a TKA.
Curettage and Allograft Reconstruction for Giant Cell Tumours
Authors: Morii T , Yabe H , Morioka H , Suzuki Y , Anazawa U , Toyama Y
Published: October 2016

Purpose.

To evaluate treatment outcomes in patients with giant cell tumours after curettage and allograft reconstruction and to identify the risk factors for poor oncological and functional outcome.

Methods.

29 patients with giant cell tumours of bone who underwent curettage and allograft reconstruction were retrospectively reviewed. The adjuvants used were heat treatment by electrocautery and hot water. Types of allograft used, time to bone union, complications, functional outcomes, and risk factors for poor function were analysed.

Results.

The mean time to bone union was 2.8 (range, 1–5) months. In 7 patients the tumours recurred (6 within 2 years); the 5-year recurrence-free survival rate was 77%. Three recurrences were classified as grade III and 4 as grade II; recurrence and the Campanacci grade showed a trend towards association (p=0.06). Tumour in the distal femur was a risk factor for postoperative fracture (p=0.02). Functional outcomes were excellent in 20 patients, good in 6, fair in 2, and a failure in one. The risk factors for poor function were recurrence (p=0.002) and joint instability (p=0.008) but not the Campanacci grade (p=0.10) or postoperative fracture (p=0.76). Lung metastasis, infection, and non-union were not encountered.

Conclusion.

Despite a relatively high recurrence rate (24%), 26 (90%) of the 29 patients had excellent/good functional outcomes. We recommend the use of adjuvants and allografts for the management of giant cell tumours.
Disseminated Rhinosporidiosis Destroying the Talus: A Case Report
Authors: Amritanand R , Nithyananth M , Cherian VM , Venkatesh K , Shah A
Published: October 2016

Rhinosporidiosis is a chronic granulomatous fungal disease caused by Rhinosporidiosis seeberi. It usually affects the mucocutaneous tissue of the nose; bone involvement is rare. We report the clinical features, diagnosis, and management of rhinosporidiosis involving the face, forehead, and right foot. As antimicrobial therapy was ineffective, a below-knee amputation was performed.
Giant Cystic Intradural Schwannoma in the Lumbosacral Region: A Case Report
Authors: Jaiswal A , Shetty AP , Rajasekaran S
Published: October 2016

We report a case of a giant cystic intradural schwannoma of the lumbosacral region in a 30-year-old man who presented with a 2-year history of non-specific lower back pain. Lateral radiographs demonstrated scalloping of the posterior wall of L5 and the upper sacrum. Magnetic resonance imaging revealed a 12×2.3-cm intradural multi-septated cystic lesion extending from L3 to S2 with predominant hypointense signal on T1-weighted images and a mixed signal on T2-weighted images. There was heterogeneous rim enhancement of the retrosacral portion of lesions following the administration of gadolinium contrast. The tumour was completely excised. Histological investigation confirmed the diagnosis of cystic schwannoma with alternating hypercellular (Antoni A) and hypocellular (Antoni B) areas in a fibrillar background. The patient had complete relief of symptoms and remained asymptomatic after 2 years of follow-up.
Bilateral Femoral Nerve Compression and Compartment Syndrome Resulting from Influenza A–Induced Rhabdomyolysis: A Case Report
Authors: Ng YS , Li HS , Chan CW
Published: October 2016

Bilateral femoral nerve compression neuropathy caused by primary iliopsoas muscle pathology is rare. We report a case of extensive compartment syndrome of the right arm and both legs associated with bilateral femoral nerve palsy resulting from severe muscle swelling secondary to influenza A infection. Our objective is to alert physicians to the possible development of compartment syndrome in patients with influenza and severe myalgia. We also reviewed the literature on the pathophysiology and management of femoral nerve compression neuropathy.
“S” Quattro External Fixation for Complex Intra-Articular Thumb Fractures
Authors: Byrne AM , Kearns SR , Morris S , Kelly EP
Published: October 2016

Purpose.

To report outcomes in 10 patients who underwent dynamic “S” Quattro external fixation for complex fractures of the base of the thumb.

Methods.

Nine men and one woman aged 18 to 69 (mean, 31) years underwent “S” Quattro external fixation for complex fractures of the base of the thumb. The dominant hand was involved in 8 patients. Three patients had Bennett fractures, 5 had Rolando fractures, one had an open multi-fragmented fracture, and one had a fracture-subluxation. Four of them had had prior (failed) treatment with splints and/or Kirschner wires. The “S” Quattro external fixator was applied for a mean of 4.9 weeks. Patients were followed up in an out-patient setting for a mean of 10.7 months until bone union and removal of the external fixator. Finger flexor function was assessed based on total active movement (TAM). Functional outcomes were assessed using the Disability of Arm, Shoulder and Hand (DASH) questionnaire.

Results.

No pin-site infection, malunion, or non-union was encountered. Mean loss of TAM was 7.5 degrees. Five patients lost 10 degrees or more, 2 of whom lost 20 degrees (one with an open comminuted fracture and one was elderly). Four patients regained full TAM and 6 attained more than 75% TAM compared to the contralateral thumb. At the 3-year follow-up, the mean DASH score was 3.4. Four patients reported no functional disability. Poorer outcomes were reported in the 2 patients who once had lost 20 degrees of TAM.

Conclusion.

The “S” Quattro external fixator is recommended as a primary and definitive treatment modality for complex intra-articular thumb fractures when conservative and other surgical interventions have failed.
Tumour Volume and Lung Metastasis in Patients with Osteosarcoma
Authors: Munajat I , Zulmi W , Norazman MZ , Faisham WI Wan
Published: October 2016

Purpose.

To assess the association between tumour volume and occurrence of lung metastasis in patients with osteosarcoma and to determine the cut-off value.

Methods.

Records of 70 patients with histopathologically confirmed primary osteosarcoma in the extremities who had magnetic resonance imaging and computed tomography of the thorax less than one month before treatment were reviewed, with reference to the official report of tumour dimensions and lung metastasis by radiologists. The status of lung metastasis was assessed. Tumour volume was measured using the formula for an ellipsoidal mass.

Results.

Of the 70 patients with osteosarcoma, 33 (47%) had evidence of lung metastasis. Tumour volume was directly associated with occurrence of lung metastasis (p=0.048). The proportion having lung metastasis when the primary tumour volume exceeded 371 cm3 was 69%, compared to 34% in those with smaller tumours.

Conclusion.

Larger tumours are more likely to correlate with lung metastasis. Both features are predictive of patient survival and prognosis.
Verrucous Carcinoma of the Foot: A Case Report
Authors: Lesic A , Nikolic M , Sopta J , Starcevic B , Bumbasirevic M , Atkinson HDE
Published: October 2016

We present a case of verrucous carcinoma of the foot in a 34-year-old man. This is a rare, locally invasive, well-differentiated, low-grade squamous cell carcinoma, with human papilloma virus as a possible causative agent. It follows a chronic course and mimics a variety of skin lesions, delaying diagnosis by up to 15 years. The definitive diagnosis is made histologically, and treatment by wide local excision is recommended. Our patient underwent wide local excision and partial 5th metatarsal amputation because of invasive disease, local infection, and peripheral vascular disease. There were no postoperative complications. At the 10-year follow-up, there were no signs of tumour recurrence.
Osteosynthesis for a T-Shaped Fracture of the Femoral Neck and Trochanter: A Case Report
Authors: Dhar SA , Mir MR , Butt MF , Farooq M , Ali MF
Published: October 2016

Ipsilateral fractures of the femoral neck and trochanter are uncommon. We report a 30-year-old man with a T-shaped fracture separating the trochanter and neck from the head. He underwent osteosynthesis using a dynamic compression plate, screws, and pins. Bone union occurred 4 months postoperatively. At the one-year follow-up, the patient was free of pain and had no evidence of avascular necrosis. It is important to preserve the femoral head in young patients by preventing further compromise of the tenuous blood supply.
Histiocytic Osteolysis Secondary to Hyperbilirubinaemia: A Case Report
Authors: Nakamura T , Kusuzaki K , Matsubara T , Satonaka H , Shintani K , Wakabayashi T , Matsumine A , Uchida A
Published: October 2016

A 6-year-old boy with Alagille syndrome, characterised by marked hyperbilirubinaemia, presented with malunion of a pathological fracture of the femur with local bone atrophy and insufficient callus formation. During corrective osteotomy, it was noted that the femur was stained dark green, suggestive of bilirubin deposition. Histology of the resected bone revealed the presence of many histiocytes and osteoclast-like multinucleate giant cells containing bilirubin particles in the cytoplasm causing bone resorption. These findings suggest that bilirubin may activate macrophages to form osteoclast-like multinucleate giant cells, resulting in histiocytic osteolysis.
Intra-Operative Somatosensory-Evoked Potential Monitoring
Authors: Chandanwale AS , Ramteke AA , Barhate S
Published: October 2016

Purpose.

To evaluate the usefulness of intra-operative somatosensory-evoked potentials (SSEPs) in monitoring spinal cord status via the posterior tibial nerve.

Methods.

84 men and 28 women aged 16 to 66 years (72% were aged 20 to 40 years) with spinal trauma (63 in the lumbar and 49 in the thoracic spine) underwent posterior instrumentation and fusion using bone grafts. All 63 patients with lumbar spinal injury and 35 of the patients with thoracic spinal injury were treated with pedicular screws. The remaining 14 patients had their thoracic spinal injury fixed with sublaminar wires. Cortical scalp recordings were used. Baseline tracings were obtained prior to surgical intervention and after establishment of anaesthesia. If changes persisted for more than 15 to 20 minutes or if they did not show definite signs of resolution, event reversal was considered.

Results.

Of the 112 patients, 74 (66%) had no changes in Cz-Fpz patterns and neurological status, whereas 14 (13%) showed improved patterns (2 of them had the same neurological status postoperatively) and 24 (21%) displayed deteriorated patterns prompting intervention. Of the 24 patients prompting intervention, 20 improved substantially (19 had no new neurological deficits and one had deteriorated neurological status) and 4 improved minimally (2 had no new deficit and 2 had new deficits), with 88% sensitivity and 78% specificity. 15 patients were true-positives with an identifiable cause; 21 were false-positives with no neurological deterioration or recognisable cause.

Conclusion.

Intra-operative SSEP monitoring helps identify acute neurological and systemic (hypoxia or hypotension) impairment and enables prompt correction. This makes surgery available to high-risk patients and enables surgeons to carry out more extensive procedures. It also provides valuable documentation in the event of medico-legal dispute.
Staple versus Locking Compression Plate Fixation after Lateral Closing Wedge High Tibial Osteotomy
Authors: Agarwala S , Shah SB
Published: October 2016

Purpose.

To compare the results of staple versus locking compression plate fixation after closing wedge high tibial osteotomy.

Methods.

A group of 23 patients (24 knees) who underwent box high tibial osteotomy and staple fixation was compared with another group of 19 patients (22 knees) who underwent a similar procedure but with locking compression plate fixation. Both groups were followed up for 3 years. The range of movement, Hospital for Special Surgery (HSS) Knee Score, time to full weight bearing, incidence of delayed union, femorotibial angle, and stage of osteoarthritis were compared.

Results.

At 6 months after the operation, the median HSS score and the proportion of patients with excellent or good scores were significantly higher in the locking compression plate than the staple fixation group (76 vs 62, p=0.003; 75% vs 42%, p=0.0354), but not at one and 3 years. The range of movement was significantly greater in the locking compression plate fixation group in the short term (6 weeks, 3 and 6 months), but not after one year. The median time to full weight bearing was significantly shorter in the locking compression plate fixation group (86 vs 116 days, p<0.001). There were fewer delayed unions in the locking compression plate fixation group but not significantly (1 vs 5, p=0.198), possibly because of the small numbers involved. There was no difference, within the limits of measurement error, in the femorotibial angle or correction loss between the 2 groups.

Conclusion.

Locking compression plate fixation obviates the use of plaster casts, enables early mobilisation and bone union, and reduces the numbers with delayed union and the time to full weight bearing. Longer-term studies are needed to evaluate its effect on revarisation and arthropathy.